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1、Medical,Surgical,andEndoscopicManagementofGastroesophagealRefluxDiseaseDeronJTessier,MDIntroductionGastroesophagealrefluxdisease(GERD)isoneofthemostcommongastrointestinaldiseasesfacingsocietytoday.IntheUSalone,morethan19millionpeoplehavethedisease.Approx
2、imately20%ofUSadultshaveoneepisodeofGERDinaweek,withabout7%reportingsignificantdailyheartburnsymptomsrequiringsometypeoftreatment.1MedicaltreatmentsforGERD,bothprescriptionandoverthecounter,costapproximately$19billionperyearintheUS.Fortunatelythemajority
3、ofGERDsymptomsareminorandself-limiting;however,complications,includingesophagitis,Barrettsyndrome,andadenocarcinoma,areontheriseinWesterncountries,suggestingthatGERDdoesnothaveabenigncourseinallpatients.Thetermnonerosiverefluxdisease(NERD)hasbeenusedtode
4、scribethemajorityofpatientsthathaveabenign,uncomplicateddiseasecourse.ThisgrouphasGERDsymptomswithoutevidenceofesophagitisonendoscopy.TheclinicalmanagementofGERDhasevolvedrapidlysincetheearly1990swiththeintroductionofpotentmedicationsaswellaslessinvasive
5、surgicaltechniquestohelptreatpatientswithmedicallyrefractorydisease.Novelmedicationstohelppreventtransientloweresophagealsphincterrelaxations(tLESRs)arebeingdevelopedandmaybeaddedtothearmamentarium.2Additionally,endoscopictherapieshavegainedsomesupport,t
6、houghlong-termdatasuggestthatthesetechniquesarenotdurable.Thisarticlereviewsthepathophysiology,presentation,workup,treatment,andemergingtherapiesforGERDwithanemphasisonsurgicalmanagementandoutcomestohelpprimarycarephysicianshaveabetterunderstandingofther
7、oleofsurgeryinthiscomplexdisease.TerminologyTheclassificationofGERDhasbeenconfusingbecauseofnumerousdefinitionsbasedonsymptomatic,physiologic,and/ordiagnosticcriteria.Insimplisticterms,GERDreferstothepathologicrefluxofgastriccontentsintotheesophagusthrou
8、ghthegastroesophagealjunction.Thisrefluxatecanbeacidic,neutral,orbasic(bile).Itcanbegas,liquid,semisolid,oracombination.Theoperativeterminthisdefinitionispathologic,inthatbelchingandvomitingwouldnotbeconsideredpathologicbe
