Treatment of gastroesophageal reflux disease: comments from thoracic surgeon

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Author:
LI Zhi-gang(Department of Thorocic Surgery, Changhai Hospital, Shanghai 200433, China)
Journal Title:
Chinese Journal of Gastrointestinal Surgery
Issue:
Volume 15, Issue 09, 2012
DOI:
10.3760/cma.j.issn.1671-0274.2012.09.005
Key Word:
Gastroesophageal reflux disease ;Treatment; Surgical procedures

Abstract: Gastroesophageal reflux disease (GERD) is the most common gastrointestinal diagnosis recorded during visits to outpatient clinics in west countries.The prevalence of symptom-defined GERD in China is as high as 3% to 5%.As a dysfunction,GERD is characterized by reflux and heartburns.The pathophysiologic process of GERD is very complicated and subtle.The spectrum of injury from long-term reflux of acid or bile includes damage mucosa,Barrett's esophagus,dysplasia,and esophageal cancer.Therefore,the therapies of GERD should focus on controlling symptom,treating complications,and surveillance the possibility of oncologic transform.As with therapy with proton-pump inhibitors (PPI),modifying lifestyle is another most important modality for most GERD.The window of surgical treatment for GERD is narrow.Surgical therapy is alternative management approach to the patients with PPI failure,complications,or huge hernia.The laparoscopic minimally invasive procedure improves the acceptance of patients to surgical therapy,but the long-term complication and drawbacks of anti-reflux surgery cannot be ignored,and which is even more common than open procedures.The limitations of current therapy for GERD have encouraged a search for more effective treatment.The Linx sphincter augmentation device has been developed to address this gap with improvement of the barrier function of LES and reversible design if necessary.

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