Antireflux surgery improves QOL in children with or without neurological impairment

Antireflux surgery results in improved quality of life (QOL) and reduced oesophageal acid exposure in neurologically normal (NN) and impaired (NI) children in the short and medium term, according to the results of a systematic review.

The investigators reviewed articles on children undergoing antireflux surgery in whom preoperative and postoperative objective testing was performed. These studies were searched in the databases of Embase, Cinahl, Medline and PubMed from inception to April 2019. The quality of studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS) criteria.

A total of 789 articles were identified, of which only 14 (12 prospective observational and two retrospective studies) were eligible. The median MINORS score was 59.4 percent (interquartile range, 39–62.5). Follow-up ranged from 1 to 180 months. Half of the eligible studies reported assessment of validated QOL measures before and after antireflux surgery in 148 children.

Significant improvements in QOL measures among NN and NI children were reported in all studies at all follow-up points. Preoperative and postoperative investigations were reported in 11 studies in between 416 and 440 children, with follow-up ranging from 0.5 to 180 months.

Nine studies reported improvements in gastro-oesophageal reflux using 24-h oesophageal pH monitoring with or without manometry. However, there were conflicting results seen in four studies reporting gastric emptying. None of the articles reported fluoroscopy or endoscopy adequately.

“Although antireflux surgery is a common elective operation, the lack of rigorous preoperative and postoperative evaluation in the majority of patient‐reported studies is striking,” the investigators said.