Fundoplication versus medical management of gastroesophageal reflux disease: systematic review and meta-analysis
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Medical, endoscopic, and open/laparoscopic surgical methods are used to treat gastroesophageal reflux disease (GERD). This study aimed to perform a systematic review of randomized controlled trials comparing medical and surgical treatments of GERD in adult patients.
For the study, MEDLINE and EMBASE (1980–2012) were searched. Two reviewers independently assessed methodologic aspects and extracted data from eligible studies, focusing on patient-relevant outcomes. The primary outcomes were health-related and GERD-specific quality-of-life aspects. Standardized mean differences (SMDs) between treatment groups were calculated and combined using random-effect meta-analysis.
The study identified 11 publications reporting on 7 trials comparing surgical (open or laparoscopic) and medical treatment of GERD. Meta-analysis of both quality-of-life aspects showed a pooled-effect estimate in favor of fundoplication (SMD 0.18; 95 % confidence interval [CI] 0.01–0.35; SMD 0.33; 95 % CI 0.13–0.54). Heartburn and regurgitation were less frequent after surgical intervention. However, a considerable proportion of patients still needed antireflux medication after fundoplication. Nevertheless, the surgical patients were significantly more satisfied with their symptom control and showed higher satisfaction with the treatment received.
This systematic review showed that surgical management of GERD is more effective than medical management with respect to patient-relevant outcomes in the short and medium term. However, long-term studies still are needed to determine whether antireflux surgery is an equivalent alternative to lifelong medical treatment.
KeywordsFundoplication Gastroesophageal reflux Anti-ulcer agents Proton pump inhibitors Review Meta-analysis
We thank Dr. Michaela Hänsel, Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, for her help in performing the literature search and screening of eliglible articles. This work was conducted only with the resources of the Institute for Social Medicine and Epidemiology, University of Lübeck, Germany, and the Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Germany.
Nadja Rickenbacher, Thomas Kötter, Michael M. Kochen, Martin Scherer, and Eva Blozik have no conflicts of interests or financial ties to disclose.
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