Are Incisionless Fundoplication Procedures a Safer Alternative to the Laparoscopic Nissen for the Treatment of Chronic Gastroesophageal Reflux Disease?

Excerpt

Gastroesophageal reflux disease (GERD) is a complex disease that can be characterized by a broad spectrum of clinical symptoms. It is the most common upper gastrointestinal disorder in the western civilization with an increasing prevalence and incidence in the last two decades.1 It has been estimated that 15–25% of adults experience gastroesophageal reflux symptoms at least weekly, and 5–12% suffer these symptoms on a daily basis.2,3 The primary barrier to reflux is the esophagogastric junction which consists of the intrinsic lower esophageal sphincter (LES), extrinsic compression of the LES by the crus, intraabdominal position of the sphincter, integrity of phrenoesophageal ligament, and maintenance of the angle of His.4 Although not completely understood, dysfunction or abnormalities in any of these components introduce the propensity for increased reflux. Due to complex etiology of GERD, the care and treatment ranges as wide as the spectrum of the disorder itself. Therapeutic modalities include lifestyle modification, medications, and ultimately surgical intervention. The initial and most conservative treatment of GERD is to advise lifestyle changes such as weight loss, avoiding foods that decrease LES pressure, avoiding lying down directly after eating, and raising the head of the bed while sleeping. Although there is definitive data that exist regarding the role of obesity and smoking in promoting GERD clinical manifestations, there is no evidence showing that dietary modifications improve symptoms.5 Despite the insufficient evidence to support an association between dietary behavior and GERD, some dietary interventions continue to be recommended as first-line therapy.6 …