GERD: Atypical Symptoms and Endoscopic Therapy

Atypical GERD symptoms, including cough and hoarseness, can be difficult to treat, even with proton pump inhibitors and laparoscopic surgical fundoplication. Transoral incisionless fundoplication (TIF), an endoscopic procedure, has shown long-term success for those with typical GERD. The primary aim of this systematic review was to assess TIF’s efficacy for patients with atypical GERD symptoms. 

This systematic review and meta-analysis included prospective and retrospective studies that evaluated the use of TIF in patients with atypical GERD symptoms and a follow-up period of at least 6 months. Ten studies were identified, including 1 randomized controlled trial, 4 prospective studies, and 5 retrospective studies, with a total of 564 patients (60% female; mean age, 57.0±2.3; mean body mass index, 27.7±1.7). 

The immediate success rate was 99.5%, with a serious adverse event rate of 1%. The Reflux Symptom Index (RSI) was used before and after the procedure. Each study showed a mean RSI score below the normal RSI threshold (13) post-TIF at 6- and 12-month follow-ups. The mean differences in RSI scores from preprocedure to postprocedure at 6- and 12-month follow-ups were -15.72 (95% confidence interval [CI], -12.15 to -19.29) and -14.73 (95% CI, -11.74 to -17.72), respectively.