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2014 SSAT State-of-the-Art Conference: Advances in Diagnosis and Management of Gastroesophageal Reflux Disease

  • 2014 SSAT State of the Art Conference
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Gastroesophageal reflux disease affects at least 10 % of people in Western societies and produces troublesome symptoms and impairs patients’ quality of life. The effective management of GERD is imperative as the diagnosis places a significant cost burden on the United States healthcare system with annual direct cost estimates exceeding 9 billion dollars annually. While effective for many patients, 30–40 % of patients receiving medical therapy with proton pump inhibitors experience troublesome breakthrough symptoms, and recent evidence suggests that this therapy subjects patients to increased risk of complications. Given the high cost of PPI therapy, patients are showing a decrease in willingness to continue with a therapy that provides incomplete relief; however, due to inconsistent outcomes and concern for procedure-related side effects following surgery, only 1 % of the GERD population undergoes anti-reflux surgery annually. The discrepancy between the number of patients who experience suboptimal medical treatment and the number considered for anti-reflux surgery indicates a large therapeutic gap in the management of GERD. The objective of the SSAT State-of-the-Art Conference was to examine technologic advances in the diagnosis and treatment of GERD and to evaluate the ways in which we assess the outcomes of these therapies to provide optimal patient care.

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References

  1. Dent J, El-Serag H, Wallander M, Johansson S. Epidemiology of gastro-oesophageal reflux disease: A systematic review. Gut 2005;54:710–717.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Shaheen N, Hansen R, Morgan D, Gangarosa LM, Ringel Y, Thiny MT, Russo MW, Sandler RS. The burden of gastrointestinal and liver diseases. Am J Gastroenterol 2006;101:2128–2138.

    Article  PubMed  Google Scholar 

  3. Zerbib F, Sifrim D, Tutuian R, Attwood S, Lundell L. Modern medical and surgical management of difficult-to-treat GORD. United European Gastroenterol J 2013;1:21–31.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Katz P, Gerson L, Vela M. Guidelines for the diagnosis and management of Gastroesophageal reflux disease. Am J Gastroenterol 2012;108:308–328.

    Article  Google Scholar 

  5. Finks J, Wei Y, Birkmeyer J. The rise and fall of antireflux surgery in the United States. Surg Endosc 2006;20:1698–1701.

    Article  PubMed  Google Scholar 

  6. Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, DeVault K, Fass R, Gyawali CP, Kahrilas PJ, Lacy BE, Pandolfino JE, Patti MG, Swanstrom LL, Kurian AA, Vela MF, Vaezi M, DeMeester TR. Preoperative diagnostic workup before antireflux surgery: An evidence and experience-based consensus of the Esophageal Diagnostic Advisory Panel. J Am Coll Surg 2013;217:586–597.

    Article  PubMed  Google Scholar 

  7. Xiao Y, Kahrilas PJ, Kwasny MJ, Roman S, Lin Z, Nicodème F, Lu C, Pandolfino JE. High-resolution manometry correlates of ineffective esophageal motility. Am J Gastroenterol 2012;107:1647–1654.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, Zhang X, Adhami T, Murray J, Peters J, Castell D. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: A multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 2004;99:1037–1043.

    Article  PubMed  Google Scholar 

  9. Wiener GJ, Richter JE, Copper JB, Wu WC, Castell DO. The symptom index: A clinically important parameter of ambulatory 24-hour esophageal pH monitoring. Am J Gastroenterol 1988;83:358–361.

    CAS  PubMed  Google Scholar 

  10. Mainie I, Tutuian R, Shay S, et al. Acid and non-acid reflux in patients with persistent symptoms despite acid suppressive therapy: A multicentre study using combined ambulatory impedance-pH monitoring. Gut 2006;55:1398–402.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg 2006;93:1483–1487.

    Article  CAS  PubMed  Google Scholar 

  12. Francis DO, Goutte M, Slaughter JC, Garrett CG, Hagaman D, Holzman MD, Vaezi MF. Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux. Laryngoscope. 2011;121:1902–1909.

    Article  PubMed  Google Scholar 

  13. Vaikal N, Van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. Am J Gastroenterol 2006;101:1900–1920.

    Article  Google Scholar 

  14. O’Rourke RW, Khanjee, YS, Urbach DR, Lee NN, Lockhart B, Hansen PD, Swanstrom LL. Extended transmediastinal dissection: An alternative to gastroplasty for short esophagus. Arch Surg 2003;138:735–740.

    Article  PubMed  Google Scholar 

  15. Zehetner J, Demeester SR, Ayazi S, Kilday P, Alicuben ET, DeMeester TR. Laparoscopic wedge fundectomy for Collis gastroplasty creation in patients with a foreshortened esophagus. Ann Surg 2014;206:1030–1033.

    Article  Google Scholar 

  16. Galmiche JP, Hatlebakk J, Attwood S, Ell C, Fiocca R, Eklund S, Långström G, Lind T, Lundell L; LOTUS Trial Collaborators. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: The LOTUS randomized clinical trial. JAMA 2011;305:1969–1977.

    Article  CAS  PubMed  Google Scholar 

  17. Triadafilopoulos G, DiBaise JK, Nostrant TT, Stollman NH, Anderson PK, Wolfe MM, Rothstein RI, Wo JM, Corley DA, Patti MG, Antignano LV, Goff JS, Edmundowicz SA, Castell DO, Rabine JC, Kim MS, Utley DS. The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Gastrointest Endosc 2002;55:149–156.

    Article  PubMed  Google Scholar 

  18. Wolfsen HC, Richards WO. The Stretta procedure for the treatment of GERD: A registry of 558 patients. J Laparoendosc Adv Surg Tech A 2002;12:395–402.

    Article  PubMed  Google Scholar 

  19. Go MR, Dundon JM, Karlowicz DJ, Domingo CB, Muscarella P, Melvin WS. Delivery of radiofrequency energy to the lower esophageal sphincter improves symptoms of gastroesophageal reflux. Surgery 2004;136:786–794.

    Article  PubMed  Google Scholar 

  20. Meier PN, Nietzschmann T, Akin I, Klose S, Manns MP. Improvement of objective GERD parameters after radiofrequency energy delivery: A European study. Scand J Gastroenterol 2007;42:911–916.

    Article  PubMed  Google Scholar 

  21. Noar MD, Lotfi-Emran S. Sustained improvement in symptoms of GERD and antisecretory drug use: 4-year follow-up of the Stretta procedure. Gastrointest Endosc 2007;65:367–372.

    Article  PubMed  Google Scholar 

  22. Perry KA, Banerjee A, Melvin WS. Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: A systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 2012;22:283–288.

    Article  PubMed  Google Scholar 

  23. Noar M, Squires P, Noar E, Lee M. Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: A decade later. Surg Endosc 2014;28:2323–2333.

    Article  PubMed  Google Scholar 

  24. Rinsma NF, Smeets FG, Bruls DW, Kessing BF, Bouvy ND, Masclee AA, Conchillo JM. Effect of transoral incisionless fundoplication on reflux mechanisms. Surg Endosc 2014;28:941–949.

    Article  PubMed  Google Scholar 

  25. Velanovich V. Endoscopic, endoluminal fundoplication for gastroesophageal reflux disease: Initial experience and lessons learned. Surgery 2010;148:646–651.

    Article  PubMed  Google Scholar 

  26. Wendling MR, Melvin WS, Perry KA. Impact of transoral incisionless fundoplication on subjective and objective GERD indices: A review of the published literature. Surg Endosc 2013;27:3754–3761.

    Article  PubMed  Google Scholar 

  27. Bonavina L, Saino G, Bona D, Lipham J, Ganz RA, Dunn D, DeMeester T. Magnetic augmentation of the lower esophageal sphincter: results of a feasibility clinical trial. J Gastrointest Surg 2008;12:2133–2140.

    Article  PubMed  Google Scholar 

  28. Lipham J, DeMeester T, Ganz R, Bonavina L, Saino G, Dunn DH, Fockens P, Bemelman W. The LINX(R) reflux management system: confirmed safety and efficacy now at 4 years. Surg Endosc 2012;26:2944–2949.

    Article  PubMed  Google Scholar 

  29. Ganz R, Peters J, Horgan S, Bemelman WA, Dunst CM, Edmundowicz SA, Lipham JC, Luketich JD, Melvin WS, Oelschlager BK, Schlack-Haerer SC, Smith CD, Smith CC, Dunn D, Taiganides PA. Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med 2013;368:719–727.

    Article  CAS  PubMed  Google Scholar 

  30. Pace F, Bianchi Porro G. Clinical spectrum, natural history and epidemiology of GERD. In: Ganderath FA, Kamolz T, Pointner R, eds. Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment. Vienna: Springer-Verlag, 2006, pp. 1–12.

    Chapter  Google Scholar 

  31. Nilsson G. The patient’s perspective. In: Ganderath FA, Kamolz T, Pointner R, eds. Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment. Vienna: Springer-Verlag, 2006, pp. 299–308.

    Chapter  Google Scholar 

  32. Dickman R, Fass R. The pathophysiology of GERD. In: Ganderath FA, Kamolz T, Pointner R, eds. Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment. Vienna: Springer-Verlag, 2006, pp. 13–22.

    Chapter  Google Scholar 

  33. Velanovich V. Using quality of life instruments to assess surgical outcomes. Surgery 1999;126:1–4.

    Article  CAS  PubMed  Google Scholar 

  34. Wood-Dauphinee S, Korolija D. Symptoms, health-related quality of life and patient satisfaction: Using these patient-reported outcomes in people with gastroesophageal reflux disease. In: Ganderath FA, Kamolz T, Pointner R, eds. Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment. Vienna: Springer-Verlag, 2006, pp. 269–286.

    Chapter  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of General and Gastrointestinal Surgery, The Ohio State University Medical Center, N729 Doan Hall, 410 W. 10th Avenue, Columbus, OH, 43210, USA

    Kyle A. Perry

  2. Department of Surgery, VA North Texas Healthcare System, Dallas, TX, USA

    Thai H. Pham

  3. Division of Gastroenterology, VA North Texas Healthcare System, Dallas, TX, USA

    Stuart J. Spechler

  4. Department of Surgery, Oregon Health and Science University, Portland, OR, USA

    John G. Hunter

  5. Division of General Surgery, Montefiore Medical Center, Bronx, NY, USA

    W. Scott Melvin

  6. Division of General Surgery, University of South Florida, Tampa, FL, USA

    Vic Velanovich

Authors
  1. Kyle A. Perry
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  2. Thai H. Pham
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  3. Stuart J. Spechler
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  4. John G. Hunter
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  5. W. Scott Melvin
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  6. Vic Velanovich
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Correspondence to Kyle A. Perry.

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Perry, K.A., Pham, T.H., Spechler, S.J. et al. 2014 SSAT State-of-the-Art Conference: Advances in Diagnosis and Management of Gastroesophageal Reflux Disease. J Gastrointest Surg 19, 458–466 (2015). https://doi.org/10.1007/s11605-014-2724-9

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  • DOI: https://doi.org/10.1007/s11605-014-2724-9

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