Treatment of Gastroesophageal Reflux Disease: A call for increase awareness and local research (original) (raw)

2011, Journal of the Pakistan Medical Association

Gastroesophageal reflux disease (GERD), typically presenting as heartburn, regurgitation, or dysphagia, may lead to esophagitis, Barrett's metaplasia, and esophageal adenocarcinoma. It occurs when the antireflux barrier between the stomach and esophagus is impaired. In tertiary-care centers, approximately 50% of patients with reflux symptoms have erosive esophagitis, whereas nonerosive disease is encountered in 50-70% of patients in community-based practices. Though almost never lifethreatening, GERD impairs the quality of life and work productivity. The goals of management in GERD are to relieve symptoms, heal esophagitis (if present), and prevent complications. In view of the costs, lifelong medical therapy and limitations of surgery, a variety of endoscopic techniques have been developed for the treatment of this condition. The principle of this approach is to provide an option for patients who are unsatisfied with protracted pharmacologic therapy yet wish to avoid antireflux (laparoscopic) surgery with results adversely affected by morbidity and mortality, which are unacceptable for what is essentially a benign condition. Moreover, a remarkable proportion of surgically treated patients still require daily antisecretory drugs, and a third of patients suffer from new symptoms after surgery, such as dysphagia, belching, diarrhea, and nausea. The best candidates for surgery are patients with effective relief of symptoms with medical treatment who experience frequent relapses, those with large hiatal hernia, those requiring high doses of proton pump inhibitors (PPIs), and patients unwilling to stay on continuous medical treatment.