Antireflux surgery vs medical treatment for gastroesophageal reflux disease: A meta-analysis

Table 1 Description of patients at baseline from the 11 articles included in meta-analysis

Ref.	Group	No. of patients randomized	Mean age (yr)	Female/male	Mean follow-up years	No. of patients at follow-up	Country
Mahon et al[14]	LNF	109	48	1:1.9	1	106	United Kingdom
	PPIs	108	47	1:2.6		97
Mehta et al[15]	LNF	91	47	1:2.0	6.9	91	United Kingdom
	PPIs	92	47	1:2.5		38
Grant et al[16]	LF	178	46.7	1:1.9	1	145	United Kingdom
	Best medical management(mainly PPIs)	179	45.9	1:2.2		154
Grant et al[17]	LF	178	46.7	1:1.9	5	127	United Kingdom
	Best medical management(mainly PPIs)	179	45.9	1:2.2		119
Lundell et al[6]	Open antireflux surgery	155	51	1:3.2	5	79	Sweden
	omeprazole	155	55	1:3.0		104
Lundell et al[18]	Open antireflux surgery	155	51	1:3.2	12	53	Sweden
	omeprazole	155	55	1:3.0		71
Anvari et al[19]	LNF	52	42.9	1:0.7	1	48	Canada
	PPIs	52	42.1	1:1		48
Anvari et al[20]	LNF	52	42.9	1:0.7	3	49	Canada
	PPIs	52	42.1	1:1		44
Spechler et al[21]	Open Nissen fundoplication	82	58	NR	9.1	38	United States
	Antacid and ranitidin	77	58	NR	10.6	91
Lundell et al[22]	Laparoscopic antireflux surgery	288	44.8	1:2.2	3	204	11 European countries
	Esomeprazole	266	45.4	1:3.0		208
Galmiche et al[23]	Laparoscopic antireflux surgery	288	44.8	1:2.2	5	180	11 European countries
	Esomeprazole	266	45.4	1:3.0		192

In the 11 articles, Ref. [16,17] were one study of different follow-up times, so were Ref. [6,18-20,22,23]. LNF: Laparoscopic Nissen fundoplication; PPIs: Proton pump inhibitors; LF: Laparoscopic fundoplication.

Table 2 Summary of inclusion criteria and relevant outcomes for the 7 studies included in meta-analysis

Ref.	Inclusion criteria	Relevant outcomes
Mahon et al[14]	Symptoms of GERD for at least 6 mo and pathologic reflux	PGWBI, GI well-being score, DeMeester score, pH testing
Mehta et al[15]	Symptoms of GERD for at least 6 mo and pathologic reflux pathologic reflux	DeMeester symptom score
Grant et al[16,17]	Symptoms of GERD requiring maintenance treatment with PPI (or other) for at least 12 mo, pathologic reflux	REFLUX quality-of life-score, EQ-5D, SF-36
Lundell et al[6,18]	Chronic GERD with concomitant esophagitis and response to omeprazole	PGWBI, GSRS
Anvari et al[19,20]	Chronic GERD, PPI for at least 1 yr, pathologic reflux, symptom control	GERSS, 24 h pH monitoring, EQ-5D
Spechler et al[21]	Complicated GERD(abnormal acid reflux at least 1 of the 4 disorders: Barrett esophagus, peptic esophageal ulcer, peptic esophageal stricture, or erosive esophagitis)	GRACI scores, 24 h pH monitoring, SF-36
Lundell et al[22] and Galmiche et al[23]	Chronic GERD, assessed through endoscopy, 24 h pH-metry and response to esomeprazole. Esophagitis no more than LA grade B, GERD symptoms no more than mild	GSRS

GERD: Gastroesophageal reflux disease; PPI: Proton pump inhibitor.

Table 3 Summary of risk of bias assessment for the 7 studies included in meta-analysis

Ref.	Sequence generation adequate	Allocation concealed	Blinding		Intention-to-treat analysis performed	Exact data available
			Patients	Healthcare providers
Mahon et al[14]	Yes	Unclear	No	No	No	Yes
Mehta et al[15]	Yes	Unclear	No	No	Yes	Yes
Grant et al[16,17]	Yes	Yes	No	No	Yes	Yes
Lundell et al[6,18]	Unclear	Unclear	No	No	Yes	Yes
Anvari et al[19,20]	Yes	Yes	No	No	No	Yes
Spechler et al[21]	Yes	Yes	No	No	Yes	Yes
Lundell et al[22] and Galmiche et al[23]	Unclear	Unclear	No	No	Yes	Yes