PWE-079 Use of antisecretory medication after antireflux surgery for patients with gastro-oesophageal reflux disease: a systematic review of non-randomised studies
Bibliographic record
Abstract
Introduction Although antireflux surgery is effective for selected patients with gastro-oesophageal reflux disease (GERD), some patients require further antireflux medication after a variable period. We have previously reported that 14% (95%CI 9% to 20%) of patients require antisecretory medication after antireflux surgery (ARS), based on a meta-analysis of 18 RCTs.1 Since most surgical studies examining the efficacy of ARS are not randomised, we aimed to investigate the need for further ARM after ARS in recent non-randomised studies. Methods MEDLINE and EMBASE databases were searched from 2005 up to Oct 2009 for published, English-language, non-randomised studies investigating the efficacy of ARS for GERD in adults, and reporting the use of ARM after ARS. The proportions of patients using ARM after ARS were sample size weighted and pooled by applying a random-effects model using StatsDirect 2.7.2®. Result In total, 24 clinical studies met inclusion criteria with follow-up ranging from 0 to 3 months to >10 years and most were single arm observational studies. Some studies reported data for more than one time point. Most surgical interventions were fundoplication, while a few studies only stated “anti-reflux surgery”. When all studies were pooled, regardless of the follow-up time point and only considering the last measured data for the same study, 20% (95% CI 13% to 28%) of patients required ARM after ARS (25 arms, n=7739). The corresponding data for the use of PPIs were 18% (11–25%, 20 arms, n=5994). When subgroup analyses were performed for different follow-up periods, the proportions of patients who required ARM after ARS were 15% (8–23%, 5 arms, n=1680), 24% (12–37%, 7 arms, n=1301), 18% (9–30%, 12 arms, n=5929), and 27% (18–37%, 5 arms, n=1447) for <1 year, 1–3 years, 3–5 years, and 5–10 years, respectively. The corresponding data for the use of PPIs were 14% (6–24%, 4 arms, n=836), 36% (18%–56%, 3 arms, n=225), 12% (3–25%, 9 arms, n=3572), and 21% (15–28%, 5 arms, n=1447). Conclusion After antireflux surgery, 20% of patients still require antireflux medication in non-randomised studies, and this proportion increases with the duration of follow-up to 27% after 10 years. This figure from non-randomised studies, which is higher than that from randomised studies, is probably more representative of the unmet need in clinical practice. However, some important issues remain unanswered, including the reasons for taking ARM after ARS, and the effect of loss to follow-up in long-term observational studies. Furthermore, how best to manage reflux patients who fail surgical treatment requires further investigation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.043 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.011 |
| Bibliometrics | 0.010 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".