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1、Medical,Surgical,andEndoscopicManagementofGastroesophagealRefluxDiseaseDeronJTessier,MDIntroductionGastroesophagealrefluxdisease(GERD)isoneofthemostcommongastrointestinaldiseasesfacingsocietytoday.IntheUSalone,morethan19millionpeoplehavethedisease.Approximately20%ofUSadultshaveoneepisodeofGERDinaw
2、eek,withabout7%reportingsignificantdailyheartburnsymptomsrequiringsometypeoftreatment.1MedicaltreatmentsforGERD,bothprescriptionandoverthecounter,costapproximately$19billionperyearintheUS.FortunatelythemajorityofGERDsymptomsareminorandself-limiting;however,complications,includingesophagitis,Barret
3、tsyndrome,andadenocarcinoma,areontheriseinWesterncountries,suggestingthatGERDdoesnothaveabenigncourseinallpatients.Thetermnonerosiverefluxdisease(NERD)hasbeenusedtodescribethemajorityofpatientsthathaveabenign,uncomplicateddiseasecourse.ThisgrouphasGERDsymptomswithoutevidenceofesophagitisonendoscop
4、y.TheclinicalmanagementofGERDhasevolvedrapidlysincetheearly1990swiththeintroductionofpotentmedicationsaswellaslessinvasivesurgicaltechniquestohelptreatpatientswithmedicallyrefractorydisease.Novelmedicationstohelppreventtransientloweresophagealsphincterrelaxations(tLESRs)arebeingdevelopedandmaybead
5、dedtothearmamentarium.2Additionally,endoscopictherapieshavegainedsomesupport,thoughlong-termdatasuggestthatthesetechniquesarenotdurable.Thisarticlereviewsthepathophysiology,presentation,workup,treatment,andemergingtherapiesforGERDwithanemphasisonsurgicalmanagementandoutcomestohelpprimarycarephysic
6、ianshaveabetterunderstandingoftheroleofsurgeryinthiscomplexdisease.TerminologyTheclassificationofGERDhasbeenconfusingbecauseofnumerousdefinitionsbasedonsymptomatic,physiologic,and/ordiagnosticcriteria.Insimplisticterms,GERDreferstothepathologicrefluxofgastriccontentsintotheesophagusthroughthegastr
7、oesophagealjunction.Thisrefluxatecanbeacidic,neutral,orbasic(bile).Itcanbegas,liquid,semisolid,oracombination.Theoperativeterminthisdefinitionispathologic,inthatbelchingandvomitingwouldnotbeconsideredpathologicbe
