The effects of antireflux surgery on asthmatics with gastroesophageal reflux

Background: Antireflux therapy, including surgery, has been advocated for a sthma patients with gastroesophageal reflux (GER), A recent review of medic al antireflux: therapy reported improvements in asthma symptoms and medicat ion requirements but no improvement in pullmonary function. The pullase of this article is to review the available literature on the effects of antire flux surgery in asthma. Method: Using the Medline 1966 to August 1998 database, lung disease, asthm a, and pulmonary function were combined with GER and different antireflux s urgeries, including fundoplication. Reference lists of identified articles were also reviewed. Results: Combining the terms asthma and GER identified 271 articles, includ ing 193 in English. Searching the term fundoplication identified 497 articl es, including 413 in English. Twenty-four reports addressed the effects of antireflux surgery in asthma. Only two studies were controlled. Asthmatic d ata could not be distinguished from that of other subjects in five articles . The remainder were case series, retrospective reviews rvs, or uncontrolle d studies. Ten reports included data on less than or equal to 10 patients. Two studies were only published as abstracts. A total of 417 asthma patient s were included in the identified reports. Antireflux surgery improved GER symptoms, asthma symptoms, asthma medication use, and pulmonary function in 90%, 79%, 88%, and 27%, respectively. Conclusions: Antireflux surgery may improve GER and asthma symptoms and dec rease medication requirements, but it has little effect on pulmonary functi on. The effects of until antireflux surgery on asthma are similar to those of medical antireflux therapy.