Gastroesophageal Reflux Disease: Medical or Surgical Treatment?

Abstract

Background. Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy. There has been a long-standing debate about the best treatment approach for this troublesome disease. Methods and Results. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment with PPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Conclusion. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized for every patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases.

The effect of antireflux surgery on laryngeal symptoms, findings and voice parameters

“…The value of laryngeal parameters of RFS in the evaluation of patient follow-up after anti-reflux surgery is not yet clear [11,12]. In our study, a reduction was detected in all parameters of RFS after surgery in both patient groups but in terms of the D value, only the total score and the decline in erythema/ hyperemia was found to be significant in the LPR group.…”

“…GERD symptoms can be controlled by both medical gastric acid suppression and surgical methods but this success ratio is lower in LPR [10,11]. In a study conducted by Tamhankar et al PPIs, the main drug used to treat GERD, did not reduce the amount of reflux but only changed the pH characteristics of the refluxate [19].…”

“…In recent years, with the use of endoscopy and minimally invasive techniques, surgical methods have become more suitable as a treatment method compared to the lifetime use of drugs and have gained momentum. LARS has been quite successful at treating the typical symptoms of GERD but its effect on LPR symptoms remains controversial [11,12]. More data are needed regarding laryngeal symptoms, physical findings and changes in voice parameters after surgery.…”

Laparoscopic Nissen fundoplication with mesh-hiatoplasty: Single center experience and early-term results

“…An alternative treatment alternative is antireflux surgery [4]. Laparoscopic antireflux surgery completely abolishes symptoms and reduces the need for medical therapy in a majority of patients [5]. There was endoscopically detected hiatal hernia in addition to reflux symptoms in 31% of our patients.…”

Laparoscopic Nissen Fundoplication, Single Center Experience

“…Minimal invaziv yöntemlerin cerrahide yaygın kullanılmasıyla beraber, antireflü cerrahi de ömür boyu ilaç kullanımına kıyasla daha uygun bir tedavi alternatifi haline gelmiş, bu yöntemler kullanı-larak uygulandığında, ameliyat sonrası ağrı ve hastanede kalış süresinin azaldığı ortaya konmuştur [10]. Laparoskopik antireflü cerrahi, hastaların büyük bir kısmında semptomları tamamen iyileştirmekte ve medikal tedaviye gereksinimlerini azaltmaktadır [11]. Bizim serimizdeki hastaların %78'inde reflü semptomlarıyla beraber, endoskopi ve/veya pasaj grafisi ile saptanmış hiyatus fıtığı mevcuttu.…”