Anti-reflux surgery appears to offer superior short-term symptom control and higher quality of life than medical treatment of gastroesophageal reflux disease (GERD), however, additional high-quality randomized control trials are needed to further inform surgical decision making, according to a study published in Surgical Endoscopy.
GERD is a common and morbid medical condition that affects millions of adults and children worldwide. Both medical and surgical treatment options are available and have shown efficacy for disease management. However, available evidence regarding the optimal treatment of GERD often suffers from a high risk of bias. Therefore, members of the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines committee performed a systematic review and meta-analysis to compare different medical and surgical interventions in the treatment of GERD. PubMed, Embase, and Cochrane databases were searched (2004–2019) to identify randomized control and non-randomized comparative studies, and from 1473 records, 105 studies were included.
The researchers’ analysis demonstrated that anti-reflux surgery was associated with superior short-term quality of life compared with proton pump inhibitor (PPI) therapy, but short-term symptom control was not significantly superior. Twenty-eight percent of patients undergoing operative treatment continued PPI treatment, and robotic and laparoscopic fundoplication outcomes were similar. Compared with total fundoplication, partial fundoplication was associated with higher rates of prolonged PPI usage, although there was no statistically significant difference in long-term symptom control or long-term dysphagia. Compared with maximal dissection, minimal dissection during fundoplication was associated with lower reoperation rates.
The researchers concluded, “Available evidence indicates that anti-reflux surgery offers superior short-term symptom control and higher quality of life than medical treatment of GERD, with the caveat that a proportion of patients undergoing operative treatment of GERD continue PPI treatment.” In addition, “High quality randomized comparative studies or population-based studies may inform future understanding of the optimal surgical management of GERD.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
McKinley SK, Dirks RC, Walsh D, et al. Surgical treatment of GERD: systematic review and meta‑analysis. Surg Endosc. Published online March 2, 2021. doi: 10.1007/s00464-021-08358-5