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J Gastrointest Surg. 2017 Sep;21(9):1544-1552. doi: 10.1007/s11605-017-3439-5. Epub 2017 Jun 16.

New Approaches to Gastroesophageal Reflux Disease.

Author information

1
Department of Surgery, Stanford University, Alway Building, Room M121, 300 Pasteur Drive, MC 5115, Stanford, CA, 94305, USA.
2
Department of Surgery, Stanford University, Alway Building, Room M121, 300 Pasteur Drive, MC 5115, Stanford, CA, 94305, USA. mhawn@stanford.edu.

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

PMID:
28623447
DOI:
10.1007/s11605-017-3439-5
[Indexed for MEDLINE]

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