Review of antireflux procedures for proton pump inhibitor nonresponsive gastroesophageal reflux disease

Hillman, Luke; Yadlapati, Rena; Whitsett, Maureen; Thuluvath, Avesh J.; Berendsen, Mark; Pandolfino, John E.

doi:10.1093/dote/dox054

Cited by 15 publications

(23 citation statements)

References 64 publications

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“…Loss of integrity of the EGJ, in the form of frequent TLESRs, hypotensive LES, and hiatus hernia are prime pathophysiologic abnormalities in GERD and are increasingly prevalent with worsening severity of reflux disease . Currently, surgery (laparoscopic or endoscopic) is the only reliable technique to restore EGJ integrity and reduce TLESRs . Esophagectomy is typically not indicated in benign esophageal disorders, but may rarely be a consideration with multiple‐failed ARS, in the presence of either dysplastic Barrett's esophagus or end‐stage achalasia …”

Section: Management Considerationsmentioning

confidence: 99%

“…65 Currently, surgery (laparoscopic or endoscopic) is the only reliable technique to restore EGJ integrity and reduce TLESRs. 141,142 Esophagectomy is typically not indicated in benign esophageal disorders, but may rarely be a consideration with multiple-failed ARS, in the presence of either dysplastic Barrett's esophagus or end-stage achalasia. 143…”

Section: Alternative Therapiesmentioning

confidence: 99%

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Nonerosive reflux disease: clinical concepts

Gyawali

Azagury

Chan

et al. 2018

Annals of the New York Academy of Sciences

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Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

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Section: Management Considerationsmentioning

confidence: 99%

Section: Alternative Therapiesmentioning

confidence: 99%

Nonerosive reflux disease: clinical concepts

Gyawali

Azagury

Chan

et al. 2018

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

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“…Moreover, transient lower esophageal sphincter relaxation (TLESR) is also correlated with pathologic reflux . Anti‐reflux surgery to structurally restore the incompetent anti‐reflux barrier effectively controls reflux symptoms and improves patient's quality of life . However, in some patients, postoperative side effects, including dysphagia, flatulence, and gas‐bloat syndrome remain a major concern .…”

Section: Introductionmentioning

confidence: 99%

“…Anti‐reflux surgery to structurally restore the incompetent anti‐reflux barrier effectively controls reflux symptoms and improves patient's quality of life . However, in some patients, postoperative side effects, including dysphagia, flatulence, and gas‐bloat syndrome remain a major concern . Endoscopic approaches, such as magnetic sphincter augmentation, transoral incisionless fundoplication, and radiofrequency therapy, have shown promising results with minimal adverse effects .…”

Section: Introductionmentioning

confidence: 99%

“…However, in some patients, postoperative side effects, including dysphagia, flatulence, and gas‐bloat syndrome remain a major concern . Endoscopic approaches, such as magnetic sphincter augmentation, transoral incisionless fundoplication, and radiofrequency therapy, have shown promising results with minimal adverse effects . Currently, an LES electric stimulation therapy has also gained attention as a result of effective control of esophageal acid exposure and elimination of reflux symptoms .…”

Section: Introductionmentioning

confidence: 99%

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Elevation of Lower Esophageal Sphincter Pressure With Acute Transcutaneous Electrical Acustimulation Synchronized With Inspiration

Liu

Guo

et al. 2019

Neuromodulation: Technology at the Neural Interface

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Laparoscopic antireflux surgery for refractory gastroesophageal reflux disease: long-term clinical outcomes

et al. 2023

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Persistent symptoms despite adequate Proton Pump Inhibitors (PPI) treatment are described in up to 40% of patients with Gastroesophageal Reflux Disease (GERD). The efficacy of Laparoscopic Antireflux Surgery (LARS) in PPI non-responder patients is still unclear. This observational study aims to report the long-term clinical outcomes and predictors of dissatisfaction in a cohort of refractory GERD patients submitted to LARS. Patients with preoperative refractory symptoms and objective GERD evidence submitted to LARS between 2008 and 2016 were included in the study. Primary endpoint was overall satisfaction with the procedure, secondary endpoints were long-term GERD symptom relief and endoscopic findings. Univariate and multivariate analyses were performed to compare satisfied and dissatisfied patients, in order to identify preoperative predictors of dissatisfaction. A total of 73 refractory GERD patients who underwent LARS were included in the study. At a mean follow-up of 91.2 ± 30.5 months, the satisfaction rate was 86.3%, with a statistically significant reduction in typical and atypical GERD symptoms. Causes of dissatisfaction were severe heartburn (6.8%), gas bloat syndrome (2.8%), and persistent dysphagia (4.1%). Multivariate analysis showed that a number of Total Distal Reflux Episodes (TDRE) > 75 was a predictive factor of long-term dissatisfaction after LARS while a partial response to PPI was a protective factor against dissatisfaction. LARS guarantees a high level of long-term satisfaction for selected refractory GERD patients. An abnormal TDRE at 24 h-multichannel intraluminal impedance-pH monitoring and the lack of response to preoperative PPI were predictors of long-term dissatisfaction.

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Review of antireflux procedures for proton pump inhibitor nonresponsive gastroesophageal reflux disease

Cited by 15 publications

References 64 publications

Nonerosive reflux disease: clinical concepts

Nonerosive reflux disease: clinical concepts

Elevation of Lower Esophageal Sphincter Pressure With Acute Transcutaneous Electrical Acustimulation Synchronized With Inspiration

Laparoscopic antireflux surgery for refractory gastroesophageal reflux disease: long-term clinical outcomes

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