Page 21 - Jourmal of World Association of Laparoscopic Surgeon

WJOLS

10.5005/jp-journals-10033-1176
What Should be the Approach in the Long-term Management of Patients with Gastroesophageal Reflux Disease?
REVIEW ARTICLE
What Should be the Approach in the Long-term

Management of Patients with Gastroesophageal

Reflux Disease?

Mohamed Solih

ABSTRACT ‘troublesome’ if they affect the individual’s well being. 1
GERD is one of the most common upper gastrointestinal
Objective: The aim of this study is to review available treatment
options and to review current opinions in the management of diseases in the Western countries and is reported to have a
patients with chronic gastroesophageal reflux disease (GERD). prevalence of 10 to 20%. GERD has been recognized as a
2-5
Materials and methods: This is a review article. Articles for clinical entity since 1930s. From a surgical perspective
the literature review were collected by using Google Search GERD is viewed as a mechanical disorder resulting from
Scholar Engine. Literature search included relevant original and failure of antireflux barrier between the esophagus and the
review articles addressing issues like medical treatment for
GERD, surgical treatment for GERD, studies comparing surgical stomach. However, the exact nature of the antireflux barrier
and medical treatment for GERD. is not well-established but the lower esophageal sphincter,
GERD is a common and chronic syndrome. Patients affected the diaphragmatic crura and phrenoesophageal ligament are
with syndrome experience symptoms which affect their quality considered as crucial elements of the antireflux barrier.
of life.
The goals of treatment in this condition is to control Failure of this barrier results in reflux of gastric contents
symptoms, heal injured esophageal mucosa and to prevent into the esophagus. Mechanical causes of failure causing
complications. Both proton pump inhibitor (PPI) therapy and GERD include: Defective lower esophageal sphincter,
antireflux surgery are equally effective in controlling symptoms
and in healing esophageal mucosal injury. In the recent years, gastric emptying disorder or failure of esophageal peristalsis.
laparoscopic surgery is increasingly been offered to patients The result of failure of antireflux barrier ranges from
with GERD. However, there is still controversy over best symptoms like ‘heartburn’ to structural damage to
approach to management of GERD. This study attempted to esophagus with or without further complications. GERD
6,7
review current opinions of this issue.
manifestations can be grouped into esophageal and
Conclusion: PPIs is an option for initial management of GERD. extraesophageal syndromes. The esophageal syndromes
However, this condition been a chronic condition, relapse is
common while on therapy with medications or following include the typical reflux syndrome, the reflux chest pain
discontinuation of therapy. Hence, a treatment option which syndrome and the syndromes with esophageal injury. The
provides effective control of symptoms and prevents or esophageal injury may range from reflux esophagitis; reflux
minimizes complications has to be offered to patients. Medical esophageal stricture, Barrett’s esophagus to esophageal
therapy with PPI and laparoscopic antireflux surgery, both can
achieve these therapeutic goals. Hence, in the light of this adenocarcinoma, and the extraesophageal syndrome include
literature review it is recommended to individualize the treatment chronic cough, asthma, otitis media and laryngitis. The
offered to the patient with GERD, in consultation with the patient extraesophageal manifestations are thought to be due to
himself or herself.
reflux of gastric contents into the respiratory tract. 8
Keywords: Acid suppression therapy, Long-term safety of PPIs, GERD is a chronic disease and, hence, the approach to
Side-effects of PPIs, Surgical management of GERD, Clinical its management aims at controlling the symptoms and to
outcomes, PPIs vs laparoscopic fundoplication.
prevent relapse. Symptomatic relief and relapse control can
How to cite this article: Solih M. What Should be the Approach be reasonably achieved with proton pump inhibitors (PPIs)
in the Long-term Management of Patients with Gastro-
esophageal Reflux Disease? World J Lap Surg 2013;6(1): and has been the main stay of treatment for GERD but this
23-28. approach fails to correct the motor abnormalities of the upper
gastrointestinal tract that are associated with GERD. 9
Source of support: Nil
Alternative to PPI drug therapy is surgery. It was Nissen in
Conflict of interest: None declared 1951, who had first performed fundoplication and first
laparoscopic fundoplication was reported in 1991 and the
INTRODUCTION
latter has rapidly replaced conventional Nissen
10
Montreal consensus defines gatroesophageal reflux disease fundoplication as the surgical therapy for GERD. It is also
(GERD) as ‘a condition which develops when the reflux of been reported that laparoscopic fundoplication is
stomach contents causes troublesome symptoms and/or increasingly been offered for GERD patients as an
complications’. Symptoms are considered to be alternative to long-term medical management. This is
World Journal of Laparoscopic Surgery, January-April 2013;6(1):23-28 23