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Journal of Gastrointestinal Surgery

, Volume 21, Issue 9, pp 1544–1552 | Cite as

New Approaches to Gastroesophageal Reflux Disease

  • William Kethman
  • Mary HawnEmail author
Evidence-Based Current Surgical Practice

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.

Keywords

Advances Gastroesophageal reflux disease GERD Erosive esophagitis Nerd Functional heartburn Esophageal hypersensitivity Surgery Endoscopy 

Notes

Acknowledgements

None.

Authors’ Contributions

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.

Compliance with Ethical Standards

Financial Support

None.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  1. 1.Department of SurgeryStanford UniversityStanfordUSA

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