Endoscopic Anti-reflux Therapy

Gastro-esophageal reflux disease (GERD) has increased substantially in the developed world over the past 30 years [1]. Epidemiological data show a prevalence of heartburn at least once weekly of about 20% [2]. GERD seriously affects quality of life. Variables such as daily fitness, vitality, emotional control, and quality of sleep are notably diminished compared with the healthy population [3], [4]. The severity and frequency of symptoms correlates not only with the presence and extent of organic lesions. Some 50–60% of patients do not have visible tissue changes on endoscopy [5], [6], which means that they have endoscopically negative reflux disease (NERD, stage 0, according to Savary and Miller). The role of endoscopy is to help in staging the disease and, quintessentially, in the early recognition of complications such as Barrett’s esophagus or adenocarcinoma, which have become increasingly common in tandem with the increase in reflux disease [7], [8]. The treatment of choice is acid suppression with a medical drug, preferably with a proton pump inhibitor. Some 90% of patients are completely complaint free on such a regimen [9]. General measures such as weight reduction, sleeping with a raised upper body, and dietary changes have shown only marginal or no effects in studies [10]–[13]. Even with long-term use, the side effects of drug treatment are negligible relative to their usefulness [14]. For selected patients, an alternative to medical drugs is surgical treatment, i.e., laparoscopic fundoplication after Nissen or Toupet. The indications for surgical anti-reflux treatment according to the European Study Group for Antireflux-Surgery are the following: