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Invited Commentary
May 2, 2019

Outcomes Data on Surgical Therapies for Silent Reflux

Author Affiliations
  • 1Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Digestive Disease Center, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Otolaryngol Head Neck Surg. 2019;145(7):667-668. doi:10.1001/jamaoto.2019.0340

In a systematic review in this issue of JAMA Otolaryngology–Head & Neck Surgery, Lechien et al1 report a systematic review of studies that examined the efficacy of surgical fundoplication for patients with laryngopharyngeal reflux (LPR) disease. In their extensive analysis starting with 266 articles and ending with 34 studies meeting inclusion criteria, a total of 2190 patients were studied and the analysis showed that, after fundoplication, 83% of patients experienced partial relief of symptoms and 67% of patients experienced complete relief of symptoms. The authors acknowledge limitations of their study based on the heterogeneity in inclusion and exclusion criteria, measurements, patient-reported outcomes, and blinding, and because assessment for improvement varied considerably, leading to an inability to truly establish the efficacy rate of surgical fundoplication for LPR. Most studies used a pH test without impedance to determine abnormal reflux parameters. Differences in patient-reported outcomes and clinical outcomes for cure varied, leading to the inability to have a criterion standard for inclusion or accurate measurements of treatment success. The authors conclude that uniformity in diagnosis, trial design, and end points can help answer questions regarding the management of LPR.

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