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Role of LES Augmentation for Early Progressive Disease in GERD and Fundoplication for End-Stage Disease in GERD

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Diagnosis and Treatment of Gastroesophageal Reflux Disease

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Abstract

Gastroesophageal reflux disease (GERD) is the most common foregut disorder with two main therapies, medical therapy with proton pump inhibitors (PPIs) and surgical therapy with anti-reflux procedures. With experience, it has become evident that a proportion of patients on PPIs will manifest incomplete relief of their symptoms and develop new symptoms, which leads to higher doses of PPIs. The evaluation of the lower esophageal sphincter (LES) has shown that sphincter failure can be a dynamic failure of a normal sphincter or permanent failure secondary to a structurally damaged sphincter. The progression from a dynamic to a permanent failure is associated with progressive disease. This has led to an evolution in our approach and treatment of patients with GERD. The modern approach to anti-reflux surgery is moving towards utilizing a form of sphincter augmentation for dynamic failure of the sphincter to prevent progressive disease and a fundoplication for patients with complete structural damage of the LES and end-stage disease. Consequently, the availability of both sphincter augmentation and surgical fundoplication requires a more sophisticated approach to GERD. Now more than ever, anti-reflux surgery requires proper patient selection, proper procedure selection, and proper performance of the surgical procedure.

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Authors and Affiliations

  1. Department of Surgery, Keck Medical Center of University of Southern California, 892 Huntington Garden Drive, San Marino, 91108, Los Angeles, CA, USA

    Stephanie G. Worrell MS, MD & Tom R. DeMeester MD

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  1. Stephanie G. Worrell MS, MD
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  2. Tom R. DeMeester MD
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  1. Department of Gastroenterology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    Michael F. Vaezi

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Worrell, S., DeMeester, T. (2016). Role of LES Augmentation for Early Progressive Disease in GERD and Fundoplication for End-Stage Disease in GERD. In: Vaezi, M. (eds) Diagnosis and Treatment of Gastroesophageal Reflux Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-19524-7_8

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  • DOI: https://doi.org/10.1007/978-3-319-19524-7_8

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