Longer Term Clinical Outcomes after Radiofrequency Therapy for refractory Gastroesophageal Reflux Disease (GERD)

INTRODUCTION G astroesophageal reflux disease (GERD) is extremely common and encompasses a diverse spectrum of clinical presentations. It has a substantial impact on patient quality of life and use of health care resources (1). GERD results from failure of the lower esophageal sphincter (LES) and cardia to prevent return of gastric contents into the esophagus. The pathophysiology of GERD is multifactorial and includes the occurrence of inappropriate, non-swallow related LES relaxations, and low resting pressure of the LES. This episodically exposes the esophageal body to gastric acid and enzymes (2). Reflux usually manifests as heartburn and regurgitation, and predisposes to the development of esophagitis, Barrett’s metaplasia, and esophageal adenocarcinoma (3). Current therapy for GERD begins with lifestyle changes and medical treatment, which prove to be adequate or effective in more than 95% of patients. Such therapy must usually be maintained long term as the recurrence rate of symptoms is as high as 90% after cessation of medication. In addition, long term drug therapy is associated with issues of cost, compliance, and long term safety (4). Patients who do not tolerate or respond adequately to medication or who wish to avoid life-long drug therapy may be considered surgical candidates. Such surgery necessitates general anesthesia, has a mortality of approximately 0.2%, and can be associated with A SPECIAL ARTICLE