Recent Advances in the Invasive Treatment of Gastroesophageal Reflux Disease

The term gastroesophageal reflux disease (GERD) describes any symptomatic condition or histopathologic alternation resulting from episodes of gastroesophageal reflux. It usually manifests as heartburn, regurgitation, or dysphagia, and predisposes to development of esophagitis, stricture, Barrett's metaplasia, esophageal adenocarcinoma, and a substantial decreased in the quality of life. Conventional pharmacotherapy (proton pump inhibitor;PPI) is effective, but is associated with a high relapse after discontinuing medication. Laparoscopic Nissen fundoplication is an alternative management regimen for young, healthy patients with severe disease. However, extreme caution is advised in regard to its significant morbidity, high reoperation rate, and an approximate 0.2% mortality rate. Recently, a number of endoscopic or endoluminal approaches have been developed aimed at impro-ving the function of the esophagogastric junction to prevent gastroesophageal reflux and may be ca-tegorized into injection bulking, endoluminal plication, and radiofrequency Stretta procedures. The procedural mechanisms, associated benefits and cost advantages are of interest to researchers. In the present study, we discuss the mechanisms, benefits, and outcomes of each individual option. To date, no standard therapy guideline has been recommended since the appearance of these new endosco-pic procedures. According to limited preliminary data, a new guideline can be established for clinical practice. ( J Intern Med Taiwan 2004; 15: 237-248 )