title: Predictors of clinical outcomes following fundoplication for gastroesophageal reflux disease remain insufficiently defined: a systematic review.
abstract: OBJECTIVE
  Surgical treatment is a therapeutic option for patients with gastroesophageal reflux disease (GERD). It is unclear which patient characteristics influence postoperative success. The purpose of this paper was to review the literature on prognostic factors for patients with GERD treated with fundoplication.
  
  
  METHODS
  We searched Medline and the Cochrane Library Central for studies from 1966 through July 2007. We identified additional studies by reviewing bibliographies of retrieved articles and by consulting experts. We included English language studies that evaluated factors potentially affecting the outcomes after surgical treatments in patients with GERD. We recorded baseline patient characteristics associated with treatment efficacy, details on the study design, comparators, and definitions of outcomes.
  
  
  RESULTS
  We assessed 6,318 abstracts; 53 cohorts and 10 case-control studies met our inclusion criteria. Age, body mass index, sex, esophagitis grade, and dysmotility were generally not associated with treatment outcomes. There were no consistent associations between preoperative response to acid suppression medications, baseline symptoms, baseline acid exposure, degree of lower esophageal sphincter competence, or position of reflux and surgical outcomes. Certain psychological factors might be associated with worse treatment outcomes.
  
  
  CONCLUSIONS
  Although several preoperative predictors of surgical outcomes have been described, the quality and consistency of the data were mixed and the strength of the associations remains unclear. Additional studies with improved methodological designs are needed to better define which patient characteristics are associated with surgical outcomes following fundoplication.
authors.affiliation: Tufts Evidence-Based Practice Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts 02111, USA. SIp@tuftsmedicalcenter.org
authors.forename: Stanley
authors.initials: S
authors.lastname: Ip
authors.forename: Athina
authors.initials: A
authors.lastname: Tatsioni
authors.forename: Alene
authors.initials: A
authors.lastname: Conant
authors.forename: Raffi
authors.initials: R
authors.lastname: Karagozian
authors.forename: Linda
authors.initials: L
authors.lastname: Fu
authors.forename: Priscilla
authors.initials: P
authors.lastname: Chew
authors.forename: Gowri
authors.initials: G
authors.lastname: Raman
authors.forename: Joseph
authors.initials: J
authors.lastname: Lau
authors.forename: Peter
authors.initials: P
authors.lastname: Bonis
mesh_terms: D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D011379:Prognosis; D016896:Treatment Outcome