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Fundoplication versus oral proton pump inhibitors for gastroesophageal reflux disease: a systematic review and meta-analysis of randomized clinical trials

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Abstract

Gastroesophageal reflux disease (GERD) is a widely studied and highly prevalent condition. However, few are reported about the exact efficacy and safety of fundoplication (FPT) compared to oral intake proton-pump inhibitors (PPI). This systematic review and meta-analysis of randomized clinical trials (RCT) aims to compare PPI and FPT in relation to the efficacy, as well as the adverse events associated with these therapies. Search carried out in June 2020 was conducted on Medline, Cochrane, EMBASE and LILACS. Selection was restricted to RCT comparing PPI and FPT (open or laparoscopic) in GERD patients. Certainty of evidence and risk of bias were assessed with GRADE Pro and with Review Manager Version 5.4 bias assessment tool. Ten RCT were included. Meta-analysis showed that heartburn (RD =  − 0.19; 95% CI =  − 0.29, − 0.09) was less frequently reported by patients that underwent FPT. Furthermore, patients undergoing surgery had greater pressure on the lower esophageal sphincter than those who used PPI (MD = 7.81; 95% CI 4.79, 10.83). Finally, FPT did not increase significantly the risk for adverse events such as postoperative dysphagia and impaired belching. FPT is a more effective therapy than PPI treatment for GERD, without significantly increasing the risk for adverse events. However, before indicating a possible surgical approach, it is extremely important to correctly assess and select the patients who would benefit from FPT to ensure better results.

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Acknowledgements

LST received a research award from Brazil’s Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (Grant Number 155512/2019-6).

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Authors and Affiliations

  1. Department of Evidence-Based Medicine, Centro Universitário Lusíada, R. Oswaldo Cruz, 179, Santos, São Paulo, 11045-101, Brazil

    Luca Schiliró Tristão, Francisco Tustumi, Guilherme Tavares & Wanderley Marques Bernardo

  2. Department of Evidence-Based Medicine, Universidade de São Paulo, São Paulo, São Paulo, Brazil

    Francisco Tustumi & Wanderley Marques Bernardo

  3. Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil

    Francisco Tustumi

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  1. Luca Schiliró Tristão
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Correspondence to Luca Schiliró Tristão.

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LST reports grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), during the conduct of the study. The other authors declare that they have no conflict of interest.

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Tristão, L.S., Tustumi, F., Tavares, G. et al. Fundoplication versus oral proton pump inhibitors for gastroesophageal reflux disease: a systematic review and meta-analysis of randomized clinical trials. Esophagus 18, 173–180 (2021). https://doi.org/10.1007/s10388-020-00806-w

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