Surgical intervention for the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is for the most part a functional problem involving the esophageal lower sphincter resulting in reflux of gastric acid. Refluxed acid may subsequently cause classic symptoms such as heartburn, but additionally atypical symptoms of pneumonia and asthma. Several modalities can be used to characterize the disease, including esophagogastroduodenoscopy, pHmetry, and manometry. Specific indications for the surgical treatment of GERD have been recommended and surgery has been shown to reduce the need for postoperative medical treatment in most of the cases. An analysis of surgery vs medicine reveals a cost-equivalent point at roughly 10 years. Although fundoplication remains the goal standard for the surgical treatment of GERD, multiple variations exist, including Nissen, Toupet, and Dor, each incurring its own respective benefits and associated risks. Alternatives to funcloplication, such as the magnetic bead antireflux systems, have also been developed and are gaining favor throughout the world in large part owing to their ease of placement and Favorable clinical results thus far. Nearly two-thirds of U.S. adults at some point in their lifetimes are affected by the common problem of GERD. The disease not only adversely affects an individual's well-being but also progression of GERD may eventually result in Barrett's esophagus and if left untreated, esophageal cancer. Modern antireflux surgeries offer a highly cost-etfective solution to GERD with minimal morbidity when compared with lifelong antisecretory therapy. (C) 2015 Elsevier Inc. All rights reserved.