Surgical Treatment of Gastroesophageal Reflux Disease

Gastro-esophageal reflux disease (GERD) is “a condition which develops when the reflux of stomach contents causes troublesome symptoms (i.e., at least two heartburn episodes per week) and/or complications” (Vakil et al 2006) and represents one of the fastest growing disease affecting the alimentary tract. Recently studies on the epidemiology of GERD demonstrating that GERD is a highly prevalent disorder with 10-20% of individuals affected in western civilization (Dent et al 2005). When GERD is defined as twice weekly reflux over several months, 10-20% of individuals in Western civilization are affected, which is significantly higher than in Asian population (5%) (Bonatti et al 2008). In a large prospective American cohort study is reported that 25% of investigated individuals experienced nocturnal reflux symptoms (Fass et al 2005). A recent population-based study demonstrated the prevalence of reflux symptoms to be 44% with 24% of individuals experiencing symptoms for two days or more per week. The prevalence of oesophagitis and Barrett’s oesophagus was 12% and 1.3% respectively, irrespective of symptoms (Zagari et al 2008).Thirty-three per cent of individuals with oesophagitis and 46% with Barrett’s oesophagus were asymptomatic. Severe GERD can lead to potentially avoidable complications including severe oesophagitis with scarring and stricture formation, Barrett’s esophagus and adenocarcinoma.When symptoms become frequent and severe enough to require regular medication, there is a significant impact on quality of life (Ware et al 1992).(QOL)