Outcome of surgical fundoplication for extraesophageal (atypical) manifestations of gastroesophageal reflux disease in adults: a systematic review Iqbal M, Batch A J, Spychal R T, Cooper B T CRD summary The authors concluded that most patients with extra-oesophageal manifestations of gastro-oesophageal reflux appeared to improve after surgery, but a small percentage were unchanged or worse; firm conclusions could not be drawn and further research was required. The conclusions reflected limited evidence from diverse observational studies, but lack of reporting of review methods made it difficult to comment on their reliability. Authors' objectives To evaluate the effects of surgery on adults with extra-oesophageal manifestations of gastrointestinal reflux. Searching MEDLINE via PubMed and Cochrane Database of Systematic Reviews were searched from 1991 to December 2006 for studies published in English. Search terms were reported. Studies were traced using the related articles function and references were screened. Study selection Studies that evaluated surgery for adults with extra-oesophageal manifestations of gastro-oesophageal reflux (extra- oesophageal reflux) were eligible for inclusion. Outcomes of interest were resolution or improvement in symptoms, quality of life and adverse events. The included studies evaluated four different types of open fundoplication and three types of laparoscopic fundoplication procedures (details reported in the review). Patients had a variety of extra-oesophageal symptoms, including asthma, chronic cough, laryngeal symptoms, combined symptoms and chest pain. Most patients were selected on the basis of oesophagogastroduodenoscopy in addition to a variety of other tests. Studies reported a variety of different outcome measures, including asthma symptoms, lung function, symptoms, pH, medication use and quality of life. Where reported, the mean duration of follow-up ranged from 3.2 to 108 months. The authors stated neither how papers were selected for the review nor how many reviewers performed the selection. Assessment of study quality The authors did not state that they assessed validity. Data extraction For each study, percentages of patients with cure and improved symptoms were presented. The authors stated neither how data were extracted for the review nor how many reviewers performed the data extraction. Methods of synthesis The studies were grouped by extra-oesophageal symptoms and combined in a narrative synthesis. Differences were apparent from data extraction tables and were discussed in the text. Results of the review Twenty-five studies were included: one randomised controlled trial (RCT, n=62); and 24 case series (10 prospective and 14 retrospective; n=9 to 354). Asthma (one RCT, n=62 and six case series, n=287) : The RCT reported higher rates of sustained improvement in the surgical group compared to H2-receptor antagonist groups and an unspecified control group (74% versus 9.1% and 4.2%). The cure rate was 6% in the fundoplication group. Long-term follow-up data were available for only 16 patients. Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2017 University of York Page: 1 / 3