Background: A significant proportion of patients with gastroesophageal reflux disease (GERD) present with atypical symptoms (extraesophageal reflux; EER). The effectiveness of surgical fundoplication in treating classical reflux symptoms is well documented, but the role of surgery in alleviating EER symptoms is less clear. The aim of this study was to review the published literature to determine whether surgical fundoplication is effective in controlling EER.
Materials and methods: A Medline, PubMed, and Cochrane database search was done to find articles on surgery for extraesophageal reflux (1991-2006). Articles on pediatric patients were excluded. The parameters looked at were patient selection, resolution of symptoms, change in the quality of life, and any adverse outcomes.
Results: In 25 studies, a variable proportion (15-95%) of patients with various symptoms of EOR improved after surgical fundoplication. The percentage of patients with EER responding to surgery was less than that reported for classical GERD.
Conclusions: The majority of patients in most studies seem to improve symptomatically after surgery. However, a small percentage remains unchanged or worsens. The reported studies are so disparate in their methodology that firm conclusions on the role of surgery are difficult. Further studies are needed. These should be large, multicenter, prospective trials comparing medical and surgical treatment with standardized diagnostic criteria for EER. Pre- and post-treatment assessment, the type of surgery performed, and follow-up should be standardized.