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New Approaches to Gastroesophageal Reflux Disease

  • Evidence-Based Current Surgical Practice
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disorder of the esophagus. It is a chronic, progressive disorder that presents most typically with heartburn and regurgitation and atypically with chest pain, dysphagia, chronic cough, globus, or sore throat. The mainstay for diagnosis and characterization of the disorder is esophagoduodenoscopy (EGD), high-resolution esophageal manometry, and symptom-associated ambulatory esophageal pH impedance monitoring. Additional studies that can be useful in certain clinical presentations include gastric scintigraphy and oral contrast upper gastrointestinal radiographic series.

Discussion

Refractory GERD can be surgically managed with various techniques. In obese individuals, laparoscopic Roux-en-Y gastric bypass should be considered due to significant symptom improvement and lower incidence of recurrent symptoms with weight loss. Otherwise, laparoscopic Nissen fundoplication is the preferred surgical technique for treatment of this disease with concomitant hiatal hernia repair when present for either procedure. The short-term risks associated with these procedures include esophageal or gastric injury, pneumothorax, wound infection, and dysphagia. Emerging techniques for treatment of this disease include the Linx Reflux Management System, EndoStim LES Stimulation System, Esophyx® and MUSE™ endoscopic fundoplication devices, and the Stretta endoscopic ablation system. Outcomes after surgical management of refractory GERD are highly dependent on adherence to strict surgical indications and appropriate patient-specific procedure selection.

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Authors and Affiliations

  1. Department of Surgery, Stanford University, Alway Building, Room M121, 300 Pasteur Drive, MC 5115, Stanford, CA, 94305, USA

    William Kethman & Mary Hawn

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William Kethman was substantially involved in the conception, drafting, and final approval of the intellectual content contained within this manuscript and he agrees to be accountable for all aspects of the work to ensure questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Mary Hawn was substantially involved in the conception, revision, and final approval of the intellectual content contained within this manuscript and she agrees to be accountable for all aspects of the work to ensure questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Mary Hawn.

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Disclosure Information: Authors: Wiliam Kethman, M.D., received non-financial support from Endogastric Solutions and Mary T. Hawn, M.D., has nothing to disclose. Editor-in-Chief: Jeffrey B. Matthews, M.D., has nothing to disclose. CME Overseers: Arbiter: Jeffrey B. Matthews, M.D., has nothing to disclose; Vice-Arbiter: Melanie Morris, M.D., has nothing to disclose; Question Reviewers: Jonathan Critchlow, M.D., has nothing to disclose; P. Marco Fisichella, M.D., has nothing to disclose.

CME questions for this article available to SSAT members at http://ssat.com/jogscme/

Learning Objectives

1. To discuss advances in diagnosis and classification of reflux syndromes and which respond best to intervention.

2. To explain the advantages, disadvantages, and outcomes for novel interventions for gastroesophageal reflux disease.

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Kethman, W., Hawn, M. New Approaches to Gastroesophageal Reflux Disease. J Gastrointest Surg 21, 1544–1552 (2017). https://doi.org/10.1007/s11605-017-3439-5

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