The effects of antireflux surgery on asthmatics with gastroesophageal reflux.

BACKGROUND Antireflux therapy, including surgery, has been advocated for asthma patients with gastroesophageal reflux (GER). A recent review of medical antireflux therapy reported improvements in asthma symptoms and medication requirements but no improvement in pulmonary function. The purpose of this article is to review the available literature on the effects of antireflux surgery in asthma. METHOD Using the Medline 1966 to August 1998 database, lung disease, asthma, and pulmonary function were combined with GER and different antireflux surgeries, including fundoplication. Reference lists of identified articles were also reviewed. RESULTS Combining the terms asthma and GER identified 271 articles, including 193 in English. Searching the term fundoplication identified 497 articles, including 413 in English. Twenty-four reports addressed the effects of antireflux surgery in asthma. Only two studies were controlled. Asthmatic data could not be distinguished from that of other subjects in five articles. The remainder were case series, retrospective reviews, or uncontrolled studies. Ten reports included data on < or = 10 patients. Two studies were only published as abstracts. A total of 417 asthma patients 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 decrease medication requirements, but it has little effect on pulmonary function. The effects of antireflux surgery on asthma are similar to those of medical antireflux therapy.