Pujitha Kudaravalli, MBBS1, Tehseen Hammad, MBBS2, Venkata Satish Pendela, MD3, Erik Klein, MD4, Hammad Ur Rahman, MD1; 1State University of New York Upstate Medical University, Syracuse, NY; 2Services Hospital, Lahore, Punjab, Pakistan; 3Rochester General Hospital, Rochester, NY; 4State University of New York Upstate Medical Center, Syracuse, NY
Introduction: The evidence has suggested that anti-reflux surgery is beneficial in patients with proton-pump inhibitor (PPI) refractory erosive gastroesophageal reflux disease (ERD). The outcomes of surgical intervention in patients with PPI refractory non-erosive reflux disease (NERD) compared to ERD remains unclear. Methods: 5 prospective observational studies investigating the outcomes of anti-reflux surgery in PPI refractory-NERD and -ERD were selected using PubMed, EMBASE and MEDLINE databases (inception April 2020). The primary endpoint was post-surgical GERD symptom resolution. The secondary endpoints were short-term (≤ 1-year) and long-term ( >1-year) mean improvement in quality of life (QOL). The outcomes were measured as relative risk (RR) and standardized mean difference (SMD) with a 95% confidence interval (CI) using the fixed effect model. Results: In analysis comprising of 670 patients with a mean age of 47.6±3.1 years and 60.5% males, the anti-reflux surgery led to significantly higher GERD symptom resolution in the ERD group as compared to the NERD group as shown in figure 1 (RR: 1.15, 95% Cl 1.01-1.31, P=0.04, I2=0). There was significant improvement in short-term QOL in both NERD (SMD: 0.28, 95% Cl 0.13-0.44, P< 0.001, I2=0) and ERD groups (SDM: 0.34, 95% Cl 0.18-0.50, P< 0.001, I2=0). Similarly, long-term QOL significantly improved after surgery in both NERD (SDM: 0.30, 95% Cl 0.14-0.45, P< 0.001, I2=13) and ERD groups (SDM: 0.23, 95% Cl 0.07-0.39, P=0.005, I2=0). Discussion: Anti-reflux surgery achieved greater GERD symptom resolution in patients with PPI-refractory ERD as compared to NERD, however, improved short- and long-term QOL in PPI refractory GERD irrespective of mucosal changes evidenced on endoscopy. Randomized controlled trials are required to further validate this data.
Figure 1: Forest Plot demonstrating GERD symptom resolution after anti-reflux surgery in PPI refractory non-erosive gastroesophageal reflux disease (NERD) and erosive esophageal reflux disease (ERD)
Disclosures: Pujitha Kudaravalli indicated no relevant financial relationships. Tehseen Hammad indicated no relevant financial relationships. Venkata Satish Pendela indicated no relevant financial relationships. Erik Klein indicated no relevant financial relationships. Hammad Ur Rahman indicated no relevant financial relationships.