Aim of the Study
To determine the effect of antireflux surgery (ARS) with regards objective measures of quality of life (QoL) and the utility of upper GI investigations in neurologically normal (NN) and neurologically impaired (NI) children.
A systematic review [according to PRISMA guidelines] was conducted to identify all articles reporting on children undergoing ARS in whom pre- and post-operative QoL assessment and/or upper GI investigations were performed. Databases included CINAHL, EMBASE, Medline, Cochrane, Web of Science and Scholar. Conference proceedings and unpublished data were screened additionally. Article quality was assessed using Jadad and MINORS criteria as appropriate.
Of 778 screened articles, 20 studies met the eligibility criteria but reporting was adequate for 14. Twelve were prospective observational studies and 2 were retrospective series. Median MINORS score was 9.5 (IQR 4.5). Seven studies reported the assessment of validated QoL measures before and after ARS in a total of 148 children. Follow-up ranged from 1 month to 15 years. All studies confirmed significant improvements in QoL measures amongst NN and NI children at all follow-up points. Eleven studies reported on investigations pre- and post-operatively in a total of 440 children. Follow-up ranged from 1 week to 15 years. Nine studies confirmed improvements in reflux control using 24h oesophageal pH monitoring +/- manometry, but conflicting results were identified for the 3 studies reporting gastric emptying data. No studies reported results of contrast studies or endoscopy(s) adequately.
Of the low to moderate quality of studies here identified, in short and medium-term follow-up, ARS appears to improve QoL and reduces oesophageal acid exposure without appreciable changes in oesophageal motility in both NN and NI children. Despite ARS being a common elective operation, the lack of pre- and post-operative measures in the vast majority of reported studies is striking.