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Endoscopic Management of Gastroesophageal Reflux Disease: Revisited

Zaheer Nabi|D Nageshwar Reddy
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2016.09|Clinical Endoscopy|제49권 제5호|pp. 408-416

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참고문헌

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SurgeryGastroesophageal refluxEndoscopyFundoplicationCatheter ablation
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초록

Gastroesophageal reflux disease (GERD) is defined by the presence of troublesome symptoms resulting from the reflux of gastric contents. The prevalence of GERD is increasing globally. An incompetent lower esophageal sphincter underlies the pathogenesis of GERD. Proton pump inhibitors (PPIs) form the core of GERD management. However, a substantial number of patients do not respond well to PPIs. The next option is anti-reflux surgery, which is efficacious, but it has its own limitations, such as gas bloating, inability to belch or vomit, and dysphagia. Laparoscopic placement of magnetic augmentation device is emerging as a useful alternative to conventional anti-reflux surgery. However, invasiveness of a surgical procedure remains a concern for the patients. The proportion of PPI non-responders or partial responders who do not wish for anti-reflux surgery defines the ‘treatment gap’ and needs to be addressed. The last decade has witnessed the fall and rise of many endoscopic devices for GERD. Major endoscopic strategies include radiofrequency ablation and endoscopic fundoplication devices. Current endoscopic devices score high on subjective improvement, but have been unimpressive in objective improvement like esophageal acid exposure. In this review, we discuss the current endoscopic anti-reflux therapies and available evidence for their role in the management of GERD.

Abstract

Gastroesophageal reflux disease (GERD) is defined by the presence of troublesome symptoms resulting from the reflux of gastric contents. The prevalence of GERD is increasing globally. An incompetent lower esophageal sphincter underlies the pathogenesis of GERD. Proton pump inhibitors (PPIs) form the core of GERD management. However, a substantial number of patients do not respond well to PPIs. The next option is anti-reflux surgery, which is efficacious, but it has its own limitations, such as gas bloating, inability to belch or vomit, and dysphagia. Laparoscopic placement of magnetic augmentation device is emerging as a useful alternative to conventional anti-reflux surgery. However, invasiveness of a surgical procedure remains a concern for the patients. The proportion of PPI non-responders or partial responders who do not wish for anti-reflux surgery defines the ‘treatment gap’ and needs to be addressed. The last decade has witnessed the fall and rise of many endoscopic devices for GERD. Major endoscopic strategies include radiofrequency ablation and endoscopic fundoplication devices. Current endoscopic devices score high on subjective improvement, but have been unimpressive in objective improvement like esophageal acid exposure. In this review, we discuss the current endoscopic anti-reflux therapies and available evidence for their role in the management of GERD.

참고문헌 (48)

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Current Trends in the Management of Gastroesophageal Reflux DiseaseDalbir S. Sandhu, Ronnie Fass거트앤리버 소화기연관학회협의회 · Gut and Liver2018 · 제12권 제1호Endoscopic Treatment of Refractory Gastroesohageal Reflux Disease김원희, 박필원, 함기백, 홍성표대한소화기내시경학회 · Clinical Endoscopy2013 · 제46권 제3호Role of endoscopy in gastroesophageal reflux diseaseDaniel Martin Simadibrata, Elvira Lesmana, Ronnie Fass대한소화기내시경학회 · Clinical Endoscopy2023 · 제56권 제6호Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux diseaseAbraham Joel, Alakh Konjengbam, Emily Hammond, Georgios Kourounis, Helen Frank, Hena Hidayat, Shivani Kuttuva, Simon Mbarushimana, Srivishnu Thulasiraman, Yirupaiahgari Viswanath대한소화기내시경학회 · Clinical Endoscopy2024 · 제57권 제1호The Outcome of Endoscopic Radiofrequency Anti-Reflux Therapy (STRETTA) for Gastroesophageal Reflux Disease in Patients with Previous Gastric Surgery: A Prospective Cohort StudyEdward John Nevins, James Edward Dixon, Yirupaiahgari Krishnaiah Setty Viswanath대한소화기내시경학회 · Clinical Endoscopy2021 · 제54권 제4호In Which Situation is Endoscopic Radiofrequency Anti-Reflux Therapy (Stretta) Effective for Controlling Gastroesophageal Reflux Symptoms?Hwoon-Yong Jung대한소화기내시경학회 · Clinical Endoscopy2021 · 제54권 제4호

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