Endoscopic treatment of Gastro Esophageal Reflux Disease: a tune-up

The incidence of Gastro-Esophageal Reflux Disease in the population of industrialized countries is high and ranges from 20 t! o 40% in the age groups between 45-64 years with a further increase in the incidence in the age between 6474. The natural history of the disease requires continuous recrudescence alternated with quiescent phases. In view of these epidemiological data it is clear the importance of the social problem and the high health costs. It follows the interest of Pharmaceutical Companies the Companies of Electromedical and producing toolkits endoscopic and surgical Companies. In this article I intend to make a brief stock of the situation about the gastro-esophageal reflux disease. I will make a tour of the clinical presentation the increase of incidence especially of so-called atypical forms and symptoms of gastropharingeal reflux (high reflux) emphasizing how many patients are refractory to therapy. Patients who benefit from medical treatment they become dependent on care. Whereas many are young and that medical therapy has adverse side effects such as anemia osteoporosis and infections is the need for alternative therapies. Physiotherapy global posture for example can be a transient and partial support. The ultimate solution is or should be surgical. Surgical therapy makes use of minimally invasive or laparoscopic method which shortens the hospital stay. But an endoscopic surgery easy repeatable free from postoperative complications can be performed in day surgery would be ideal for this type of chronic disease. In reviewing the different techniques that have been proposed over the last twenty years I relate the considerations derived from the international literature. Conclude by presenting a last device manufactured in Germany derived from its precursor the NDO Plicator which making use of the addition of heads polytetrafluoroethylene (PTFE) which retain the suture threads from the traction exerted by the tissues seem to improve the seal in time. I make a brief summary of the main endoscopic therapies for the disease by reflusso.Io believe that there is room for this type of therapeutic approach which is a step before surgery. Epidemiology and Clinical Presentation The incidence of reflux disease or Gastro-Esophageal reflux disease or Gastro-Laryngeal reflux disease reaches up to over 50% of the general population. The natural history of the disease includes periods of wellness alternating with periods of exacerbation. The flat mucosa of the esophagus is not designed to withstand the irritating contents which come from the stomach. The regurgitation from the stomach therefore create disorder with or without tissue damage associated. Gastric reflux irritates the esophagus and larynx. The symptoms are caused by the refluxed acid or alkali or mixed which comes from the stomach and the duodenum. Often there is no match between the symptoms and organ damage documented: this is called N.E.R.D. (Not Esophagitis Reflus Disease). The quality of life is highly invalidated and gastroscopy shows an almost normal finding. Incontinence of the cardia which is documented causes serious trouble. The organ damage can be erosions and ulcers and there is the possibility of an inflamed tissue transformation in metaplastic sense (Barrett’s esophagus) and dysplastic. This is a precancerous lesion. More frequently the continuous recurrence of reflux does not cause organ damage but causes a major inconvenience. The clinical presentation is manifested by typical symptoms of heartburn and regurgitation or with cardiac neurological symptoms ENT and pneumological such as palpitations chest pain headache cough laryngitis the burning mouth otitis the bronchopathies a sense of suffocation even in the absence of the classic heartburn.