Anti-reflux surgery for controlling respiratory symptoms of gastro-esophageal reflux disease: A systematic review and meta-analysis

• Main Authors: Francisco Tustumi, Wanderley Marques Bernardo, Julio Rafael Mariano da Rocha, Sérgio Szachnowicz, Francisco Carlos Bernal da Costa Seguro, Edno Tales Bianchi, Flávio Roberto Takeda, Antonio Afonso de Miranda Neto, Rubens Antonio Aissar Sallum, Ivan Cecconello
• Format: Article
• Language: English
• Published: Elsevier 2021-01-01
• Series: Asian Journal of Surgery
• Subjects: Systematic review; meta-Analysis; Obstructive lung diseases; Respiratory hypersensitivity; Fundoplication; Gastro-esophageal reflux
• Online Access: http://www.sciencedirect.com/science/article/pii/S1015958420301597

Gastro-esophageal reflux disease (GERD) patients have a higher prevalence of airway symptoms, such as chronic cough, wheezing, and hoarseness. The therapeutic management of patients with these symptoms is controversial. Therefore, this study aims to perform a systematic review and meta-analysis evaluating the efficacy of anti-reflux surgery for controlling respiratory symptoms related to GERD. A systematic review and meta-analysis was performed. Extraction of the data concerning proportions of participants who were not free of respiratory symptoms related to GERD (cough, wheezing, hoarseness) or not substantially improved at follow-ups (failure to cure) was performed. Of the 3,424 initially screened articles, 68 studies were included for systematic review and 61 were included for meta-analysis, with a cumulative sample size of 3,869 patients. Of all the included patients, after anti-reflux surgery, the general symptoms improvement was 80% (95% CI 75.2–84%). The numbers needed to harm (NNH) and the numbers needed to treat (NNT) were 15.21 and 1.23, respectively. Of the included patients, 83.4% (95% CI 78.3–87.5%) patients reported improvement in cough symptoms after surgery. For the wheezing symptom, 71.5% (95% CI 62.9–78.8%) reported improvement after surgery. Moreover, surgery presented better results in improving respiratory symptoms than medical therapy (risk difference: −0.46; 95% CI -0.77, −0.16). Physicians should strongly consider surgical anti-reflux procedures for controlling respiratory symptoms in GERD patients after proper patient selection. Anti-reflux surgery has shown high efficacy in improving respiratory symptoms related to GERD, even when compared to medical therapy.