Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 26, 2015; 3(6): 284-294
Published online Dec 26, 2015. doi: 10.13105/wjma.v3.i6.284
Antireflux surgery vs medical treatment for gastroesophageal reflux disease: A meta-analysis
Ya Jiang, Wen-Xia Cui, Ying Wang, Ding Heng, Jia-Cheng Tan, Lin Lin
Ya Jiang, Wen-Xia Cui, Ying Wang, Ding Heng, Jia-Cheng Tan, Lin Lin, Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Jiang Y and Cui WX acquisition of data, analysis and interpretation of data, drafting the article, final approval; Wang Y, Heng D and Tan JC interpretation of data, revising the article, final approval; Lin L conception and design of the study, critical revision, final approval.
Supported by The Project of Jiangsu Province Department of Health, No. H201328; the Project of Jiangsu Provincial Administration of traditional Chinese Medicine, No. LZ13225; the Postgraduates’ Innovation Program supported by the Education Department of Jiangsu Province, No. Jx22013279.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lin Lin, MD, PhD, Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. lin9100@aliyun.com
Telephone: +86-25-68136920 Fax: +86-25-83674636
Received: June 9, 2015
Peer-review started: June 11, 2015
First decision: August 4, 2015
Revised: September 29, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: December 26, 2015
Processing time: 198 Days and 11.2 Hours
Abstract

AIM: To compare the effect of antireflux surgery with medicine in treating gastroesophageal reflux disease (GERD) patients using meta- analysis.

METHODS: MEDLINE, Embase and the Cochrane Library were searched. We only included randomized controlled trials (RCTs) comparing the effect of surgical intervention with medical therapy for GERD. Statistical analyses were performed using RevMan 5.2 and STATA 12.0 software. RevMan 5.2 was used to assess the risk of bias and calculate the pooled effect size, while Stata 12.0 was used to evaluate publication bias and for sensitivity analysis. We evaluated the primary outcomes with GERD-/health-related quality of life in short (one to three years) and long (three to twelve years) periods of follow-up. Secondary outcomes evaluated were DeMeester scores and the percentage of time that pH < 4 to evaluate the degree of acid exposure.

RESULTS: This meta-analysis included 7 studies with 1972 patients. It showed a positive effect of antireflux surgery compared with medical treatment in terms of health-related quality of life [standardized mean difference (SMD) = 0.18; 95%CI: 0.01 to 0.34] and GERD-related quality of life (SMD = 0.35; 95%CI: 0.11 to 0.59). We also conducted the subgroup analyses based on follow-up periods and found that surgery remained more effective than medicine over the short to medium follow-up time, but the advantage of antireflux surgery probably not maintained for long time. GERD-related quality of life in the surgical group was significantly higher than medical group for the < 3 years follow-up (SMD = 0.45; 95%CI: 0.23 to 0.66); the difference was not statistically significant when the follow-up time was ≥ 3 years (SMD = 0.30; 95%CI: -0.10 to 0.69). Meta-analysis showed a statistically significant difference between the surgical group and medical group in the percentage of time that pH < 4 (SMD = 0.38; 95%CI: 0.14 to 0.61). Meta-analysis indicated a positive effect of antireflux surgery compared with medical treatment concerning DeMeester scores (SMD = 0.32; 95%CI: 0.00 to 0.65).

CONCLUSION: Although both were effective, in some respects surgical intervention was more effective than medical therapy to treat GERD when follow-up time was up to three years.

Keywords: Gastroesophageal reflux disease, Antireflux surgery, Medical treatment, Meta-analysis

Core tip: The advantage of our study is its systematic approach to identifying all randomized controlled trials comparing surgical intervention with medical therapy for gastroesophageal reflux disease (GERD). We conducted the subgroup analyses based on follow-up periods and concluded that antireflux surgery may in some ways be more effective than medicine over short to medium follow-up periods, but its effect declined over time. We also completed analyses for the percentage of time pH < 4 and DeMeester scores. Both analyses favored surgery over medical treatment. However, long-term studies are still required to determine whether surgical intervention is better than medicine in treating GERD patients.