New Approaches to Gastroesophageal Reflux Disease
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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.
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.
KeywordsAdvances Gastroesophageal reflux disease GERD Erosive esophagitis Nerd Functional heartburn Esophageal hypersensitivity Surgery Endoscopy
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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- 1.Camilleri M, Dubois D, Coulie B, et al. Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US Upper Gastrointestinal Study. Clin Gastroenterol Hepatol. 2005;3(6):543–552. http://www.ncbi.nlm.nih.gov/pubmed/15952096. Accessed December 1, 2016.
- 6.Ismail-Beigi F, Horton PF, Pope CE. Histological consequences of gastroesophageal reflux in man. Gastroenterology. 1970;58(2):163–174. http://www.ncbi.nlm.nih.gov/pubmed/5413015. Accessed January 2, 2017.
- 8.Vakil N, van Zanten S V., 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(8):1900–1920. doi: 10.1111/j.1572-0241.2006.00630.x.CrossRefPubMedGoogle Scholar
- 12.Galindo G, Vassalle J, Marcus SN, Triadafilopoulos G. Multimodality evaluation of patients with gastroesophageal reflux disease symptoms who have failed empiric proton pump inhibitor therapy. Dis esophagus Off J Int Soc Dis Esophagus. 2013;26(5):443–450. doi: 10.1111/j.1442-2050.2012.01381.x.CrossRefGoogle Scholar
- 14.Montgomery M, Håkanson B, Ljungqvist O, Ahlman B, Thorell A. Twelve months’ follow-up after treatment with the EndoCinch endoscopic technique for gastro-oesophageal reflux disease: a randomized, placebo-controlled study. Scand J Gastroenterol. 2006;41(12):1382–1389. doi: 10.1080/00365520600735738.CrossRefPubMedGoogle Scholar
- 15.Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172–180. http://www.ncbi.nlm.nih.gov/pubmed/10403727. Accessed January 2, 2017.
- 17.Bortoli N de, Martinucci I, Bertani L, et al. Esophageal testing: What we have so far. World J Gastrointest Pathophysiol. 2016;7(1):72. doi: 10.4291/wjgp.v7.i1.72.
- 18.Leggett CL, Gorospe EC. Application of confocal laser endomicroscopy in the diagnosis and management of Barrett’s esophagus. Ann Gastroenterol Q Publ Hell Soc Gastroenterol. 2014;27(3):193–199. http://www.ncbi.nlm.nih.gov/pubmed/24976007. Accessed December 1, 2016.
- 20.Kahrilas PJ, Shaheen NJ, Vaezi MF, American Gastroenterological Association Institute, Clinical Practice and Quality Management Committee. American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1392–1413, 1413-5. doi: 10.1053/j.gastro.2008.08.044.CrossRefPubMedGoogle Scholar
- 21.Subramanian CR, Triadafilopoulos G. Refractory gastroesophageal reflux disease. Gastroenterol Rep. 2014. doi: 10.1093/gastro/gou061.
- 26.Who is a Candidate for Bariatric Surgery? - American Society for Metabolic and Bariatric Surgery. https://asmbs.org/patients/who-is-a-candidate-for-bariatric-surgery.
- 28.Sutherland V, Kuwada T, Gersin K, Simms C, Stefanidis D. Impact of Bariatric Surgery on Hiatal Hernia Repair Outcomes. Am Surg. 2016;82(8):743–747. http://www.ncbi.nlm.nih.gov/pubmed/27657592. Accessed February 5, 2017.
- 29.Pallati PK, Shaligram A, Shostrom VK, Oleynikov D, McBride CL, Goede MR. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: Review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2014;10(3):502–507. doi: 10.1016/j.soard.2013.07.018.CrossRefPubMedGoogle Scholar
- 30.Bonavina L, Saino G, Bona D, et al. One Hundred Consecutive Patients Treated with Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease: 6 Years of Clinical Experience from a Single Center. J Am Coll Surg. 2013;217(4):577–585. doi: 10.1016/j.jamcollsurg.2013.04.039.CrossRefPubMedGoogle Scholar
- 36.Jobe BA, O’Rourke RW, McMahon BP, et al. Transoral endoscopic fundoplication in the treatment of gastroesophageal reflux disease: the anatomic and physiologic basis for reconstruction of the esophagogastric junction using a novel device. Ann Surg. 2008;248(1):69–76. doi: 10.1097/SLA.0b013e31817c9630.CrossRefGoogle Scholar
- 40.Cowgill SM, Gillman R, Kraemer E, Al-Saadi S, Villadolid D, Rosemurgy A. Ten-year follow up after laparoscopic Nissen fundoplication for gastroesophageal reflux disease. Am Surg. 2007;73(8):748-52-3. http://www.ncbi.nlm.nih.gov/pubmed/17879678. Accessed December 2, 2016.