Asthma: antireflux surgery improved gastroesophageal reflux and asthma symptoms.

Clinical bottom line (level 3a)

  1. Patients with asthma and gastroesophageal reflux who were given antireflux surgery, were likely to have an improvement in reflux, asthma symptoms and medication use.
  2. There was no significant improvement in pulmonary function.
Field et al: Chest 1999; 116 (3): 766-774
Expires February 2003

The study

Systematic review of studies of
  • Patients: asthmatics with gastroesophageal reflux
  • Intervention: antireflux surgery
  • Outcome: improvement in reflux, asthma symptoms and use of medication


    • Articles found in English using MEDLINE, 1966 to August 1998 (search terms: GER and fundoplication combined with asthma and lung disease. Other surgical terms, including gastropexy, Belsey, Allison, Toupet, Lortat-Jacob, Boerema and the Hill procedures were combined with asthma and lung disease. ) and Reference lists of identified papers were searched.

    Selection criteria: as above
    Appraisal criteria: all studies were included due to the low number.
    Articles excluded if: no studies were excluded

    24 studies were included.

    The evidence

    • In patients given surgery, 90% had an improvement in gastroesophageal reflux.
    • 79% had an improvement in asthma symptoms.
    • 88% had an improvement in medication use.
    • 27% had an improvement in pulmonary function.

    Comments

    1. Only two of the studies were controlled trials, the others were all case series, retrospective reviews or uncontrolled trials.
    2. Some studies included patients with respiratory diseases other than asthma.
    3. Adults, children and infants were included in the studies.
    4. From this and other systematic reviews , medical anti-reflux treatment may be effective to reduce asthma symptom in subgroups of patients.

    Citation

    1. Field SK, Gelfand AJ, McFadden SD: The effects of antireflux surgery on asthmatics with gastroesophageal reflux. Chest 1999; 116 (3): 766-774
    Contributor: Clare Wotton and Musab Hayatli, February 2000
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient asthma and gastroesophageal reflux
    Intervention or Exposure antireflux surgery
    Outcome asthma symptoms, reflux