-
Esophagus : Official Journal of the... Jul 2021Gastroesophageal reflux disease (GERD) is a commonly diagnosed gastrointestinal disorder, with a substantial impact on the quality of life. The underlying... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Gastroesophageal reflux disease (GERD) is a commonly diagnosed gastrointestinal disorder, with a substantial impact on the quality of life. The underlying pathophysiology of GERD is multifactorial and incompletely understood. Abnormal gastric electrical activity, measured using electrogastrography (EGG), may contribute. This study aimed to systematically review and meta-analyse the existing literature in which EGG was used in patients with GERD.
METHODS
Databases were systematically searched for studies using EGG in adults with GERD. The primary outcome was the percentage of recording time in the normogastric frequency range. Secondary outcomes were dominant frequency, dominant power, power ratio and prevalence of any EGG abnormality.
RESULTS
In total, 591 participants (427 patients with GERD; 164 healthy controls) from 13 studies were included. GERD patients spent 17.3% (SMD - 1.18, 95%CI: - 1.84, - 0.52) and 18.7% (SMD - 1.11, 95%CI: - 1.55, - 0.68) less of the preprandial and postprandial recording time in normogastric frequency ranges, respectively, compared to healthy controls. The dominant frequency, dominant power and power ratio were not significantly different to healthy controls in the preprandial and postprandial periods. The pooled prevalence of any EGG abnormality was significantly greater in patients with GERD than in healthy controls [46% (95%CI: 39-64%) vs. 10% (95%CI: 4-23%); p < 0.0001]. Correlations between GERD symptoms and EGG recordings were inconsistently studied. EGG techniques were heterogeneous.
CONCLUSIONS
Consistent abnormalities in gastric slow-wave activity, as measured by EGG, were identified in adults with GERD. Further investigation into these abnormalities using novel emerging electrophysiology techniques is desirable, to better define their contribution toward GERD pathophysiology.
Topics: Adult; Electromyography; Gastroesophageal Reflux; Humans; Postprandial Period; Quality of Life; Stomach
PubMed: 33594598
DOI: 10.1007/s10388-021-00820-6 -
International Journal of Surgery... Mar 2018Laparoscopic Anti-Reflux Surgery (LARS) is an established alternative treatment to pharmacological therapy for patients with Gastro Osophageal Reflux Disease (GORD), yet... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Laparoscopic Anti-Reflux Surgery (LARS) is an established alternative treatment to pharmacological therapy for patients with Gastro Osophageal Reflux Disease (GORD), yet its safety and efficacy in obese patients is controversial. A systematic review and meta-analysis was performed to compare LARS related to obesity.
METHODS
Embase, MEDLINE and the Cochrane Library (January 1970 to July 2017) were searched for studies reporting clinical outcomes of LARS in patient cohorts stratified by Body Mass Index (BMI). Data was grouped according to BMI, <30 kg/m (non-obese) and ≥30 kg/m (obese). Primary outcome measures were reflux recurrence, operative morbidity, re-intervention (redo surgery and endoscopic dilatation), conversion to open surgery, and early return to theatre. Results were pooled in meta-analyses as Odds Ratios (OR).
RESULTS
Thirteen eligible observational studies comparing LARS in non-obese (n = 6246) and obese (n = 1753) patients were identified. Recurrence of reflux was significantly lower in the non-obese cohort (OR 0.28, 95% C.I. 0.13 to 0.61, p = 0.001), however no significant differences were observed in rates of operative morbidity (OR 0.82, 0.54 to 1.23, p = 0.33), redo surgery (OR 0.94, 0.51 to 1.72, p = 0.84), endoscopic dilatation (OR 0.98, 0.45 to 2.17, p = 0.97), conversion to open surgery (OR 0.96, 0.50 to 1.85, P = 0.90), or early return to theatre (OR 0.77, 0.43 to 1.38, p = 0.39).
CONCLUSIONS
LARS can be performed safely in obese patients, but risks higher GORD recurrence. Clinicians and patients should be aware that obesity may adversely affect LARS outcome and careful consideration be given in the consent process inherent within the optimal management of GORD.
Topics: Adult; Body Mass Index; Cohort Studies; Conversion to Open Surgery; Female; Fundoplication; Gastroesophageal Reflux; Humans; Laparoscopy; Male; Middle Aged; Obesity; Odds Ratio; Recurrence; Treatment Outcome
PubMed: 29367036
DOI: 10.1016/j.ijsu.2018.01.013 -
The Laryngoscope Sep 2019To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF).
OBJECTIVES
To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF).
METHODS
PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
RESULTS
Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma.
CONCLUSIONS
Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.
Topics: Clinical Trials as Topic; Humans; Laryngeal Diseases; Laryngeal Edema; Laryngopharyngeal Reflux; Polyps; Prospective Studies; Retrospective Studies; Vocal Cords
PubMed: 30892725
DOI: 10.1002/lary.27932 -
Journal of Gastroenterology and... May 2024Up to 40% of gastroesophageal reflux disease (GERD) patients experience inadequate symptom relief with a proton pump inhibitor (PPI), termed PPI-resistant or refractory... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIM
Up to 40% of gastroesophageal reflux disease (GERD) patients experience inadequate symptom relief with a proton pump inhibitor (PPI), termed PPI-resistant or refractory GERD. Vonoprazan, a potassium-competitive acid blocker, has better efficacy than PPI in suppressing gastric acid secretion. This meta-analysis summarizes the efficacy and safety of vonoprazan for treating PPI-resistant GERD (both erosive esophagitis [EE] and non-erosive reflux disease [NERD]).
METHODS
Four electronic databases (Medline, Embase, SCOPUS, and CENTRAL) were searched for studies indexed until August 1, 2023. Both observational studies and clinical trials assessing the efficacy and safety of vonoprazan in PPI-resistant GERD were included. Efficacy outcomes included healing and maintenance rates of EE and improvement of the Frequency Scale for Symptoms of GERD (FSSG) scores. Serious adverse events (SAEs) were considered a safety outcome. The modified Newcastle-Ottawa Scale (NOS) was used to assess study quality.
RESULTS
Twelve studies were included in this meta-analysis. Healing rates of PPI-resistant EE with vonoprazan 20 mg were 91.7% (95% CI 86.8-94.8%) and 88.5% (95% CI 69.7-96.2%) at weeks 4 and 8, respectively. For healed PPI-resistant EE, the overall maintenance rates with vonoprazan 10 mg were 82.6% (95% 61.2-95.0%) at week 8, 86.0% (95% CI 72.1-94.7%) at week 24, and 93.8% (95% CI 69.8-99.8%) at week 48. FSSG scores were improved in 74.6% (95% CI 65.8-81.7%) and 51.9% (95% CI 37.8-65.7%) of patients at weeks 4 and 8. Overall, no SAE was reported.
CONCLUSION
Vonoprazan demonstrated high efficacy in the healing and maintenance of PPI-resistant EE and moderate efficacy for the improvement of FSSG score. Vonoprazan was well tolerated in PPI-resistant GERD patients.
Topics: Proton Pump Inhibitors; Humans; Pyrroles; Gastroesophageal Reflux; Sulfonamides; Treatment Outcome; Drug Resistance
PubMed: 38263507
DOI: 10.1111/jgh.16475 -
The American Journal of Gastroenterology May 2024Los Angeles grade C/D esophagitis is a severe manifestation of gastroesophageal reflux disease that require active treatment and close follow-up. Potassium competitive... (Meta-Analysis)
Meta-Analysis Comparative Study
INTRODUCTION
Los Angeles grade C/D esophagitis is a severe manifestation of gastroesophageal reflux disease that require active treatment and close follow-up. Potassium competitive acid blockers (P-CAB) are promising alternatives to proton pump inhibitors (PPI). We aimed to compare the efficacy and safety of P-CAB and PPI in healing grade C/D esophagitis to aid clinical decision-making.
METHODS
A systematic literature search was performed using PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials were eligible for inclusion if efficacy of P-CAB and PPI in healing grade C/D esophagitis was reported. Pooled risk ratios and risk difference with 95% credible intervals were used to summarize estimated effect of each comparison. The benefit of treatments was ranked using the surface under the cumulative probability ranking score.
RESULTS
Of 5,876 articles identified in the database, 24 studies were eligible. Studies included incorporated 3 P-CAB (vonoprazan, tegoprazan, and keverprazan) and 6 PPI (lansoprazole, esomeprazole, omeprazole, rabeprazole extended-release (ER), pantoprazole, and dexlansoprazole). Based on the failure to achieve mucosal healing, 20 mg of vonoprazan q.d. ranked the first among PPI in initial and maintained healing of grade C/D esophagitis (surface under the cumulative probability ranking score = 0.89 and 0.87, respectively). Vonoprazan had similar risk of incurring adverse events, severe adverse events, and withdrawal to drug when compared with PPI. For those who attempted lower maintenance treatment dose, 10 mg of vonoprazan q.d. was a reasonable choice, considering its moderate efficacy and safety.
DISCUSSION
Vonoprazan has considerable efficacy in initial and maintained healing of grade C/D esophagitis compared with PPI, with moderate short-term and long-term safety.
Topics: Humans; Esophagitis; Esophagitis, Peptic; Gastroesophageal Reflux; Network Meta-Analysis; Proton Pump Inhibitors; Pyrroles; Randomized Controlled Trials as Topic; Sulfonamides; Treatment Outcome
PubMed: 38345252
DOI: 10.14309/ajg.0000000000002714 -
Surgical Endoscopy Jan 2014Medical, endoscopic, and open/laparoscopic surgical methods are used to treat gastroesophageal reflux disease (GERD). This study aimed to perform a systematic review of... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Medical, endoscopic, and open/laparoscopic surgical methods are used to treat gastroesophageal reflux disease (GERD). This study aimed to perform a systematic review of randomized controlled trials comparing medical and surgical treatments of GERD in adult patients.
METHODS
For the study, MEDLINE and EMBASE (1980-2012) were searched. Two reviewers independently assessed methodologic aspects and extracted data from eligible studies, focusing on patient-relevant outcomes. The primary outcomes were health-related and GERD-specific quality-of-life aspects. Standardized mean differences (SMDs) between treatment groups were calculated and combined using random-effect meta-analysis.
RESULTS
The study identified 11 publications reporting on 7 trials comparing surgical (open or laparoscopic) and medical treatment of GERD. Meta-analysis of both quality-of-life aspects showed a pooled-effect estimate in favor of fundoplication (SMD 0.18; 95 % confidence interval [CI] 0.01-0.35; SMD 0.33; 95 % CI 0.13-0.54). Heartburn and regurgitation were less frequent after surgical intervention. However, a considerable proportion of patients still needed antireflux medication after fundoplication. Nevertheless, the surgical patients were significantly more satisfied with their symptom control and showed higher satisfaction with the treatment received.
CONCLUSIONS
This systematic review showed that surgical management of GERD is more effective than medical management with respect to patient-relevant outcomes in the short and medium term. However, long-term studies still are needed to determine whether antireflux surgery is an equivalent alternative to lifelong medical treatment.
Topics: Adult; Anti-Ulcer Agents; Fundoplication; Gastroesophageal Reflux; Humans; Laparoscopy; Proton Pump Inhibitors; Quality of Life; Treatment Outcome
PubMed: 24018760
DOI: 10.1007/s00464-013-3140-z -
Alimentary Pharmacology & Therapeutics Oct 2008Management strategies for gastro-oesophageal reflux disease (GERD) are often inconsistent with the proposition that it is a persistent or chronic disease. (Review)
Review
BACKGROUND
Management strategies for gastro-oesophageal reflux disease (GERD) are often inconsistent with the proposition that it is a persistent or chronic disease.
AIM
To determine the persistence of reflux symptoms and complications associated with GERD.
METHODS
Systematic searches of Medline and EMBASE.
RESULTS
In longitudinal studies, 65% (95% CI 54-75%) of patients with complicated GERD and 70% (95% CI 57-83%) of patients with 'defined' GERD had persistent disease at follow-up, whereas 34% (95% CI 27-40%) with infrequent or mild reflux symptoms at baseline had persistent symptoms. Clinical trials of maintenance treatment for at least 6 months after healing of oesophagitis reported mean relapse rates of 75% (95% CI 68-82%) in patients taking placebo and 28% (95% CI 21-35%) in those taking proton pump inhibitors. Retrospective studies reported that 34-41% of individuals with GERD recalled experiencing their symptoms for >10 years. The prevalence of GERD is high (10-20%), whereas the incidence is low (4.5-19.6 cases per 1000 person-years), suggesting that GERD is likely to persist for at least 18 years.
CONCLUSIONS
Individuals with GERD have persistent reflux symptoms that merit management as a chronic disease; infrequent reflux symptoms are less likely to be chronic and may respond to different management strategies.
Topics: Chronic Disease; Clinical Trials as Topic; Evidence-Based Medicine; Gastroesophageal Reflux; Gastrointestinal Agents; Humans; Incidence; Longitudinal Studies; Prevalence
PubMed: 18637097
DOI: 10.1111/j.1365-2036.2008.03804.x -
Archives of Pediatrics & Adolescent... Feb 2002Nonpharmacological and nonsurgical measures are often recommended for gastroesophageal reflux disease (GERD) in infants, despite ambiguous supporting evidence. (Review)
Review
BACKGROUND
Nonpharmacological and nonsurgical measures are often recommended for gastroesophageal reflux disease (GERD) in infants, despite ambiguous supporting evidence.
OBJECTIVE
To conduct a systematic review of rigorously evaluated nonpharmacological and nonsurgical therapies for GERD in infants.
DESIGN/METHODS
We searched online bibliographic databases, including MEDLINE, EMBASE, the Cochrane Collaboration and Clinical Trials Database, and alternative medicine databases for the terms gastroesophageal reflux and infants. We selected randomized controlled trials of nonpharmacological and nonsurgical GERD therapies in otherwise healthy infants. Data were extracted from the selected articles regarding reflux, emetic episodes and intraesophageal pH.
RESULTS
We identified 43 relevant studies, of which 10 met the selection criteria. These studies examined positioning, pacifier use, and feeding changes. Positioning at a 60 degree elevation in an infant seat was found to increase reflux compared with the prone position. No significant difference was shown between the flat and head-elevated prone positions. The impact of pacifier use on reflux frequency was equivocal and dependent on infant position. The protein content of formula was not found to affect reflux. Although no study demonstrated a significant reflux-reducing benefit of thickened infant foods compared with placebo, 1 study detected a significant benefit of formula thickened with carob bean gum compared with rice flour (pH<4 for 5% vs 8% of time). Another study showed that if supplementing with dextrose 5% water or dextrose 10% water, the lower-osmolality fluid was associated with less reflux.
CONCLUSIONS
Many conservative measures commonly used to treat GERD in infants have no proven efficacy. Although thickened formulas do not appear to reduce measurable reflux, they may reduce vomiting. Further studies with clinical outcomes are needed to answer questions about efficacy definitively.
Topics: Gastroesophageal Reflux; Humans; Infant; Infant Food; Infant, Newborn; Prevalence; Prone Position; Randomized Controlled Trials as Topic
PubMed: 11814369
DOI: 10.1001/archpedi.156.2.109 -
Obesity Surgery Sep 2022This systematic review evaluates the indications and results of revisional bariatric surgery (RBS) in gastroesophageal reflux disease (GERD). A systematic literature... (Meta-Analysis)
Meta-Analysis Review
This systematic review evaluates the indications and results of revisional bariatric surgery (RBS) in gastroesophageal reflux disease (GERD). A systematic literature search and meta-analysis was performed for articles published by April 1, 2021. After examining 722 papers involving 17,437 patients, 48 studies were included (n = 915 patients). RBS for GERD was mostly reported after sleeve gastrectomy (n = 796, 87%) and one anastomosis gastric bypass (n = 62, 6.8%) and was performed due to intractable GERD (71.6%), GERD and weight issues (16%), and biliary reflux (6.2%). Mean follow-up of the studies was 31.5 (3-84) months. Pooled estimation of a meta-analysis of studies reported 7% of GERD following primary surgery needing RBS, in which 99% of the patients experienced remission.
Topics: Bile Reflux; Gastrectomy; Gastric Bypass; Gastroesophageal Reflux; Humans; Laparoscopy; Obesity, Morbid; Retrospective Studies
PubMed: 35776239
DOI: 10.1007/s11695-022-06183-w -
Journal of Digestive Diseases Dec 2021In this systematic review and meta-analysis we aimed to determine the efficacy and safety of magnetic sphincter augmentation (MSA) in the management of refractory... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
In this systematic review and meta-analysis we aimed to determine the efficacy and safety of magnetic sphincter augmentation (MSA) in the management of refractory gastroesophageal reflux disease (rGERD).
METHODS
Literature search was conducted in PubMed, the Cochrane Library, EMBASE, Web of Science, OpenGrey and ClincalTrials.gov for single-arm studies evaluating the efficacy and safety of MSA in rGERD or comparative studies with proton pump inhibitor (PPI) or laparoscopic Nissen fundoplication (LNF) serving as the control published until April 2020. Primary outcome was the rate of postoperative PPI use, and secondary outcomes included postoperative GERD-health-related quality of life (GERD-HRQL), normalization of acid exposure time (AET) and incidence of procedure-related adverse events (AE).
RESULTS
Ten single-arm studies, one randomized controlled trial and three cohort studies involving 1138 participants were included. Post-MSA PPI withdrawal, significant GERD-HRQL improvement and AET normalization were achieved in 87.0%, 88.0% and 75.0% of the patients, respectively. The incidence of postoperative dysphagia was 29% and endoscopic dilation was required in 7.4% of patients undergoing MSA. MSA showed a better efficacy in symptom control than PPI (PPI cessation: 91% vs 0%; GERD-HRQL improvement: 81% vs 8%) and similar effectiveness but a lower risk of gas-bloat syndrome (risk ratio [RR] 0.69, 95% confidence interval [CI] 0.51-0.93, P = 0.01) and better reserved ability to belch (RR 1.48, 95% CI 0.76-2.86, P = 0.25) compared with LNF.
CONCLUSIONS
MSA was an effective and safe therapy for rGERD. Well-designed randomized trials that compare the efficacy of MSA with other therapies are needed.
Topics: Gastroesophageal Reflux; Humans; Magnetic Phenomena; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 34693633
DOI: 10.1111/1751-2980.13063