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This publication is provided for historical reference only and the information may be out of date.

Cover of Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease: Update

Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease: Update

Comparative Effectiveness Reviews, No. 29

Investigators: , MD, , PhD, MPH, , MBBS, MS, , MS, RD, , PhD, , BS, , MD, and , MD.

Tufts Medical Center Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 11-EHC049-EF

Structured Abstract

Background:

Gastroesophageal reflux disease (GERD) is one of the most common health conditions affecting Americans. Despite the availability of medical, surgical, and endoscopic options, optimal management strategies remain unsettled.

Purpose:

The purpose was to systematically review and update our previous Comparative Effectiveness Review, which compared the effectiveness of different management options for adults with GERD.

Data Sources:

We searched MEDLINE,® Cochrane Central Register of Controlled Trials, and other relevant databases, as well as other existing systematic reviews.

Study Selection:

Studies of various designs were sought, including comparative randomized controlled trials, nonrandomized and cohort studies, and systematic reviews.

Data Extraction:

A standardized protocol was used to extract details on study design, diagnoses, interventions, outcomes, and quality.

Data Synthesis:

In total, 166 studies met eligibility criteria. We found a moderate strength of evidence that laparoscopic fundoplication in patients whose GERD symptoms were already well controlled by medical treatments was at least as effective as continued medical treatment (and in some cases superior) in controlling GERD-related symptoms for the first 1 to 3 years following surgery. However, the rate of serious adverse events was generally higher in patients who underwent fundoplication compared with those who had medical treatment. We did not identify sufficient evidence to conclude whether medical or surgical treatment was more effective in preventing long-term complications of GERD, such as the development of Barrett's esophagus or esophageal adenocarcinoma. We found a moderate strength of evidence that proton pump inhibitors were superior to histamine-2 receptor antagonists in resolving GERD symptoms at 4 weeks and promoting healing of esophagitis at 8 weeks. Evidence regarding the effectiveness of endoscopic procedures was insufficient. Evidence regarding the effectiveness of treatment of GERD on asthma symptoms was inconclusive.

Limitations:

Studies directly comparing surgery to medical therapy generally had high dropout rates in long-term followup. There was a great deal of variability in the rigor with which the outcomes were evaluated across studies, particularly in subjective endpoints.

Conclusions:

Medical therapy and laparoscopic fundoplication were similarly effective in improving GERD symptoms in patients whose symptoms were already well controlled by medical therapy for at least the first 1 to 3 years following surgery. Serious adverse events were more common after surgery. The effectiveness of endoscopic procedures remains substantially uncertain.

Contents

Update of Comparative Effectiveness Review No. 1. Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHSA 290-2007-10055-I. Prepared by: Tufts Medical Center Evidence-based Practice Center, Boston, Massachusetts

Suggested citation:

Ip S, Chung M, Moorthy D, Yu WW, Lee J, Chan JA, Bonis PA, Lau J. Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease: Update. Comparative Effectiveness Review No. 29. (Prepared by Tufts Medical Center Evidence-based Practice Center under Contract No. HHSA 290-2007-10055-I.) AHRQ Publication No. 11-EHC049-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2011. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Tufts Medical Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290-2007-10055-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www‚Äč.ahrq.gov

Bookshelf ID: NBK65406PMID: 22091471

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