Purpose: Gastroesophageal reflux disease (GERD) is one of the most common chronic gastrointestinal tracts. Medical management includes use of various antisecretory medications whereas surgical management includes fundoplication with open or laparoscopic approach. Various randomized controlled trials (RCTs) performed in past compared both forms of treatment with controversial results. Therefore, we conducted meta-analysis to compare medical versus surgical management of GERD.
Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, PubMed, and recent abstracts from major conference proceedings were searched (5/2010). RCTs comparing medical versus surgical management of GERD were included. Standard forms were used to extract data by two independent reviewers. The effects of both the methods were analyzed by calculating pooled estimates for symptom remission, complications, and cross-over to other techniques or need for other therapies to control the symptoms. Separate analyses were performed for each outcome by using odds ratio (OR) by fixed and random effects models. Publication bias was assessed by funnel plots. All were graded by Jadad score. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency.
Results: Four trials met inclusion criteria. Trials were of adequate quality (Jadad score ≥ 2). Three trials used an open technique where as one trial used a laparoscopic technique. No significant heterogeneity was noted for major outcomes. Need for additional antisecretory medication is significantly higher in surgical group versus medical group (OR 4.79; 95% CI: 1.71-13.44, p< 0.01). However, a non-significant effect was noted for symptoms remission and strictures between both groups (OR 1.24; 95% CI: 0.81-1.91, p=0.31; OR 1.99; 95% CI: 0.81-4.88, p=0.13). Funnel plot revealed no publication bias.
Conclusion: Both medical and surgical therapies are effective in symptom control with similar number of strictures; however, more patients who undergo surgical therapy for GERD are restarted on antisecretory medications despite surgery.