Gastro-esophageal reflux is the most frequent esophageal disease and scores amongst the most common problems in gastroenterology. 10% to 20% of the general population presents with heartburn. However, the majority of patients with typical GERD symptoms do not have visible lesions in the esophagus at endoscopy. This category of patients can be treated symptomatically without expensive investigations.
In the case of macroscopic lesions (esophagitis), short-term treatment is effective and allows for a cure rate of 78% to 97% after eight weeks. Unfortunately, recurrences are frequent and occur in 80% of the patients within six months. Long-term treatment, however, is very effective and provides remission rates of 85% at one year and less than 80% at 2 years.
Pathological gastro-esophageal reflux is a chronic disease, which necessitates a long term, if not life-long, treatment. Since laparoscopy greatly simplifies the postoperative course, surgery seems to be a very viable alternative to the proton pump inhibitors (PPI) in the long run.
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GERD surgical indications |
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refractory cases when the proton pump inhibitors are stopped |
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non compliant patients (psychological, socio-economical reasons); |
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who do not want to take life long medication; |
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patients with esophagitis and/or esophageal ulcers recurring immediately after treatment stop; |
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patients with severe hemorrhagic esophagitis, recurring at the end of medical treatment or with stenosis refractory to medical and endoscopic treatment; |
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patients with atypical symptoms, with standing medical treatment and in whom definite relationship has been proven between reflux and those atypical symptoms (24 h pH-metry), especially in case of large hiatal hernia. |
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