Turaga Anjani Haswitha*
Department of Surgery, Gandhi Medical College, Hyderabad, IndiaFulltext PDF
Background: Gastro-esophageal reflux disease (GERD) is a common digestive disorder characterized by the reflux of stomach contents into the esophagus. GERD can cause a range of symptoms, including heartburn, regurgitation, and chest pain. The condition can be managed with lifestyle changes, medications, or surgical intervention. While non-surgical interventions are the first line of treatment for GERD, some patients may require surgery due to the severity or chronic nature of their symptoms. There are different surgical and non-surgical interventions available for the treatment of GERD, but their relative effectiveness and safety are not well established. Therefore, a systematic review of the available literature is necessary to compare the effectiveness and safety of surgical and non-surgical interventions in the treatment of GERD
Aim: This systematic review aims to provide an up-to-date evaluation of the current evidence on the effectiveness of different surgical and non-surgical interventions for the treatment of GERD. This information can help guide clinical decision-making and improve patient outcomes. Methods: A search was conducted on PubMed, EMBASE, MEDLINE and Cochrane Library using the search strategy (Gastroesophageal reflux disease OR GERD OR reflux disease OR acid reflux) AND (Surgical intervention OR surgery OR fundoplication OR laparoscopic Nissen fundoplication OR laparoscopic Toupet fundoplication) AND (Medical intervention OR medical therapy OR proton pump inhibitors OR PPI) AND (Treatment OR management). The protocol of this review lies in accord with Preferred Reporting Items for Systematic Reviews & Meta-analyses (PRISMA). Randomized controlled and clinical trials were eligible for inclusion to the systematic review. Studies were included if the patients had confirm diagnosis of GERD and received either surgical intervention or medical therapy. Results: Three randomized controlled trials met the inclusion criteria. One study had a follow-up of 1 year, one had a follow-up of two year while the third had a follow-up of five years. A total of 1,018 patients were included with a diagnosis of gastro-esophageal reflux disease (GERD). All randomized controlled trials involved a comparison of laparoscopic Nissen fundoplication to proton pump inhibitors (PPIs) for the treatment of gastro-esophageal reflux disease (GERD). One clinical trial demonstrated that with contemporary anti-reflux therapy for GERD, either by drug-induced acid suppression with esomeprazole or by LARS, most patients achieve and remain in remission at 5 years. The second trial found that patients whose GERD symptoms are stable and controlled with PPI, continuing medical therapy and laparoscopic anti-reflux surgery are equally effective, although surgery may result in better symptom control and quality of life. The third trial documented that LNF leads to significantly less acid exposure of the lower oesophagus at 3 months and significantly greater improvements in both gastrointestinal and general well-being after 12 months compared with PPI treatment. Conclusion: The results of this systematic review suggest that both surgical and non-surgical interventions are effective in the treatment of gastro-esophageal reflux disease. Non-surgical interventions, such as proton pump inhibitors and lifestyle modifications, are generally considered as the first- line treatment for GERD. However, surgical intervention, such as laparoscopic fundoplication, may be considered for patients with severe symptoms or those who do not respond to non- surgical interventions. The overall effectiveness and safety of surgical and non-surgical interventions were found to be comparable, but surgery may be associated with a higher risk of adverse events. Therefore, the choice of treatment for GERD should be based on individual patient factors, such as symptom severity, response to initial therapy, and patient preference. Further research is needed to better define the optimal timing and indications for surgical intervention in the management of GERD.
GERD; Fundoplication; Proton pump inhibitors
Turaga Anjani Haswitha. Comparison of Surgical and Non-Surgical Interventions in the Treatment of Gastro-Esophageal Reflux Disease (GERD): Systematic Review. Int Jour Gastro Hepat. 2023;2(1):1-12.