Выходит 4 номеров в год
ISSN Печать: 1050-6934
ISSN Онлайн: 1940-4379
Indexed in
Management of Gastroesophageal Reflux Disease: Medications, Surgery, or Endoscopic Therapy? (Current Status and Trends)
Краткое описание
Gastroesophageal reflux disease (GERD) is a common chronic disorder in the Western world. The basic cause of GERD has been well characterizedthe fundamental defect is a loss of integrity of the gastroesophageal barrier. What is less clear is the most appropriate means of addressing this reflux. GERD has a variety of symptoms, ranging from typical presentations of heartburn and regurgitation (without esophagitis) to atypical presentations, such as severe erosive esophagitis and its associated complications. Because of its symptomatic diversity, physicians may select from a variety of therapeutic approaches.
Medical therapy aims at decreasing acidity by suppressing proton secretion and has been well established. Available medications include antacids and alginates, H2-receptor antagonists, motility agents, and proton pump inhibitors (PPIs). Antireflux surgery, commonly performed laparoscopically, aims at reinforcing and repairing the defective barrier through plication of the gastric fundus. The earliest performed successful procedures were the Nissen and Toupet fundoplications, to which several modifications have since been made. It has been demonstrated in preliminary studies and long-term outcomes of such open surgery and preliminary studies of such laparoscopic surgery that antireflux surgery is an effective approach, with overall outcomes superior to those achieved with medications. The precise indications for the surgical treatment of patients with GERD, however, remain controversial.
In recent years, endoscopic intraluminal antireflux approaches have attracted the attention of physicians, surgeons, and commercial companies, especially after the approval of two endoscopic intraluminal methods by the United States FDA in 2000. The common element is prevention of acid reflux by construction of a functional or controlled barrier in the lower esophageal sphincter zone. Three main methods are currently employed: endoscopic intraluminal valvuloplasty, endoscopic radiofrequency therapy, and endoscopic injection or implantation of foreign material. The endoluminal suturing method is highly demanding technically, and its short-term results are encouraging, although largely dependent on the experience of the endoscopist. Several prospective cohort studies have shown that the radiofrequency procedure (Stretta®) significantly improves GERD symptoms and quality of life while reducing esophageal acid exposure and eliminating the need for antisecretory medications in the majority of patients within 6−12 months. Most recently, some researchers have studied the endoluminal implantation of polymers, such as Plexiglas™ (polymethyl-methylacrylate), Gatekeeper® hydrogel, and Enteryx® (ethylene vinyl alcohol copolymer). The preliminary results of these studies showed that the implantation method was feasible and safe; however, the only multicenter trial related to outcome that has been published has included just 1 year of follow-up.
Here, we review the treatment of GERD: medical, surgical, and endoscopic. In addition, we provide an algorithm based on symptoms and response to treatment for management of these patients.
-
Remacle Marc, Lawson Georges, Diagnosis and management of laryngopharyngeal reflux disease, Current Opinion in Otolaryngology & Head & Neck Surgery, 14, 3, 2006. Crossref
-
von Renteln D., Caca Karel, Der Plicator – Die endoskopische Lösung der Antirefluxtherapie?, Der Gastroenterologe, 2, 2, 2007. Crossref
-
Cohen Henry, Tomasso Giselle, Luisa Cafferata María, Zapata Carlos, Sharma Prateek, Armstrong David, Moraes-Filho Joaquim P., Blasco Carmelo, Corti Rodolfo, Estape Gonzalo, Leite Luna Luiz, Ortuño Rafael, Sakai Paulo, Salis Graciela, Taullard Daniel, Trakal Esteban, Valdovinos Miguel, Vergara Maria, Gónzalez Oscar, Latin American Consensus on Gastroesophageal Reflux Disease: An Update on Therapy, Gastroenterología y Hepatología, 33, 2, 2010. Crossref
-
von Renteln Daniel, Schiefke Ingolf, Fuchs Karl-Hermann, Raczynski Susanne, Philipper Michael, Breithaupt Wolfram, Caca Karel, Neuhaus Horst, Endoscopic full-thickness plication for the treatment of GERD by application of multiple Plicator implants: a multicenter study (with video), Gastrointestinal Endoscopy, 68, 5, 2008. Crossref
-
Sidhu Anupender Singh, lopoulos George Triadafi, Neuro-regulation of lower esophageal sphincter function as treatment for gastroesophageal refl ux disease, World Journal of Gastroenterology, 14, 7, 2008. Crossref
-
Chhabra Pratyaksh, Ingole Nishikant, Gastroesophageal Reflux Disease (GERD): Highlighting Diagnosis, Treatment, and Lifestyle Changes, Cureus, 2022. Crossref