New Minimally Invasive Endoscopic and Surgical Therapies for Gastroesophageal Reflux Disease (GERD)

Abstract

RezumatBRGE a devenit cea mai frecventã afecţiune a polului digestiv superior, afecţiune spectralã şi evolutivã cu posibile complicaţii severe. Terapia principalã şi efectivã în majoritatea cazurilor este tratamentul medical (TM) axat pe IPP. Cazurile severe cu alterarea funcţiei sfincterului esofagian inferior (SEI) şi modificãri anatomice importante vor fi abordate chirurgical, fundoplicatura laparoscopicã (FL), intervenţia de elecţie, cu rezultate bune la distanţã, dar cu posibile efecte negative postoperatorii. 30-40 % dintre pacienţi sunt refractãri la TM, dar mulţi nu doresc intervenţia chirurgicalã. Apare un "gol terapeutic", pacienţi cu BRGE care nu beneficiazã de tratament. Pentru pacienţii cu BRGE, selectaţi, fãrã forme severe şi complicaţii şi fãrã modificãri anatomice importante (hernii hiatale mici), în mod special pentru cei refractari la TM, au apãrut noi terapii miniminvazive: mai eficiente ca şi TM, dar mai puţin agresive şi cu efecte secundare minime comparativ cu FL. Sunt terapii endoscopice care amelioreazã funcţia SEI prin terapie termicã, procedeul Stretta® şi rezecţia mucoasei antireflux, respectiv realizarea unei fundoplicaturi parţiale cu ajutorul unor dipozitive de agrafare: EsophyX®, Muse™, Gerd-X™. Tehnicile laparoscopice pot rezolva HH mai mari (peste 2 cm) când se impune, iar în locul fundoplicaturii se poate monta un şirag de mãrgele magnetice la nivelul joncţiunii gastroesofagiene, procedeul LINX®, respectiv electrozi pentru stimulare electricã a SEI, EndoStim®. Aceste procedee s-au dovedit

Short-Term Results of Minimally Invasive Treatment of Gastroesophageal Reflux Disease by Radiofrequency (Stretta): First Brazilian Series of Cases

“…The use of RF in the treatment of GERD was approved by the FDA in 2000. The procedure involves the delivery of RF energy to several sites along the GEJ, inducing hypertrophy and thereby increasing the tone of the LES (3,8) .…”

“…According to the Montreal Conference consensus, GERD is defined as a disease that develops when the reflux of gastric acid causes unpleasant symptoms and/or complications. It may be attributable to anatomical or physiological defects of the gastroesophageal junction (GEJ) or to altered esophageal peristalsis, and it causes typical or atypical symptoms that negatively affect the quality of life of the individual (1)(2)(3) .…”

“…The most widespread initial approach is the use of proton pump inhibitors (PPIs), alone or in combination with prokinetics, with concomitant changes in eating habits and lifestyle. However, even with adequate treatment, 20% to 40% of cases are refractory to treatment with medications, and the effect of drugs is reduced in patients with atypical symptoms (3) .…”

Gastroesophageal Reflux Caused Pharyngitis in Local Population A Comparative Clinical Study

“…In most situations, dietary and lifestyle modifications can reduce your GERD symptoms 6,7 .Though some people could require treatment or surgery. More than 60 million adults experience heartburn at least once every month, and more than 15 million adults, including many pregnant women, experience it daily 9,10 . Recent research indicates that GERD in infants and children is more prevalent than previously believed.…”

The Study of Anti-inflammatory Effect of Curcumae Longae Rhizoma 30% EtOH Extract on Chronic Acid Reflux Esophagitis Rats

“…GERD is common gastrointestinal disorders with a recurrent or chronic apparatus, the prevalence corresponds about 2.5 ~ 25%, especially, Western countries are much higher than that of Asia [4][5][6]. The cause of GERD are a reduction in lower esophageal sphincter (LES) function, alteration of esophageal peristalsis, impairment of esophageal clearance, and increase from the transient LES relaxation (TLESR) [7,8]. Furthermore, family history and lifestyles such as westernized diet, smoking, alcoholism, and social stresses increase the risk factor of GERD [6].…”