Surgical Treatment for Laryngopharyngeal Reflux Disease: A Systematic Review.

Autor:	Lechien JR; Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.; Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.; Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.; Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.; Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium., Dapri G; Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.; Department of Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium., Dequanter D; Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.; Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium., Rodriguez Ruiz A; Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.; Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium., Marechal MT; Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.; Department of Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium., De Marrez LG; Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.; Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France., Saussez S; Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.; Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.; Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.; Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium., Fisichella PM; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.; Boston Veterans Affairs Healthcare System, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2019 Jul 01; Vol. 145 (7), pp. 655-666.
DOI:	10.1001/jamaoto.2019.0315
Abstrakt:	Importance: Laryngopharyngeal reflux (LPR) is a prevalent disease that is usually treated with diet, lifestyle modifications, and proton pump inhibitor therapy. However, nearly 10% to 30% of patients do not achieve adequate acid suppression even with high doses of proton pump inhibitors. For these patients with resistant disease, fundoplication may be recommended but the success rate of fundoplication surgery on laryngopharyngeal symptoms and findings remains uncertain. Objective: To determine whether fundoplication is associated with control of signs and symptoms in patients with LPR. Evidence Review: A literature search was conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline to identify studies published between 1990 and 2018 about the efficacy of fundoplication on clinical outcomes of LPR. Three investigators screened publications for eligibility and exclusion based on predetermined criteria. Study design, patient characteristics, diagnostic method, exclusion criteria, treatment characteristics, follow-up, and quality of the outcome assessment were evaluated. Findings: Of the 266 studies identified, 34 met the inclusion criteria, accounting for 2190 patients with LPR (1270 women and 920 men; mean [SD] age at the time of surgery, 49.3 [6.3] years). A weighted mean of 83.0% of patients (95% CI, 79.7%-86.3%) experienced improvement and a weighted mean of 67.0% of patients (95% CI, 64.1%-69.9%) experienced a disappearance of symptoms, but there is a high level of methodological heterogeneity among studies according to diagnostic method, exclusion criteria, and outcomes used to assess the efficacy of fundoplication. A pH study without impedance study was used in most studies but with various inclusion criteria. According to results of an a priori assessment, the clinical outcomes used were overall poor, excluding many symptoms and findings associated with LPR. Conclusion and Relevance: The reported studies of fundoplication in LPR disease have important heterogeneity in method of diagnosis, exclusion criteria, symptoms, and signs assessed as therapeutic outcomes; therefore, this systematic review was nonconclusive regarding whether surgery for LPR disease is associated with effective control of sight and symptoms. Otolaryngologists, gastroenterologists, and surgeons must establish a diagnostic criterion standard, clear indications for surgery, and future clinical outcomes to precisely assess the effectiveness of treatment.
Databáze:	MEDLINE
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