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Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2009, Article ID 371580, 15 pages doi:10.1155/2009/371580

Review Article Gastroesophageal Reflux Disease: Medical or Surgical Treatment?
Theodore Liakakos,1 George Karamanolis,2 Paul Patapis,1 and Evangelos P. Misiakos1
1 Department

of Surgery, University of Athens School of Medicine, Attikon University Hospital,Rimini 1, Chaidari, Athens 124 62, Greece 2 Department of Internal Medicine, Gastroenterology Unit, University of Athens School of Medicine, Attikon University Hospital, Rimini 1, Chaidari, Athens 124 62, Greece Correspondence should be addressed to Evangelos P. Misiakos, misiakos@med.uoa.gr Received 8 July 2009; Revised 14 October 2009; Accepted 26 October 2009 Recommended by Ronnie FassBackground. Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy.There has been a long-standing debate about the best treatment approach for this troublesome disease. Methods and Results. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment withPPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Conclusion. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized forevery patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases. Copyright © 2009 Theodore Liakakos et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1.Introduction
Gastroesophageal reflux disease (GERD), recognized as a clinical entity only in the mid-1930s, is now the most common upper gastrointestinal disease in the Western countries, with 10%–20% of the population experiencing weekly symptoms [1–4]. Its prevalence is also increasing in the Far East (Japan) and other areas in Asia [5, 6]. This may be related to increased fat consumption in the diet,and the expanding proportion of obese individuals [7, 8]. The disease is characterized by a broad spectrum of clinical symptoms and disorders [9]. According to the Montreal definition and classification of the disease [10], GERD is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The disease encompasses esophageal and extra-esophagealsyndromes. The esophageal syndromes include the symptomatic syndromes, that is, the typical reflux syndrome and

the reflux chest pain syndrome, and the syndromes with esophageal injury, that is, reflux esophagitis, reflux stricture, Barrett’s esophagus (BE) and esophageal adenocarcinoma. The extra-esophageal syndromes are respiratory conditions, such as chronic coughing, asthma, laryngitis, otitismedia, mainly caused by the reflux of gastric juice into the respiratory tract [11]. GERD is a chronic disease characterized mainly by symptoms of heartburn and acid regurgitation during daily activities. In addition approximately 45% of the symptomatic GERD sufferers have nighttime symptoms (NTG), and patients with NTG have significantly greater odds of having moderate or severe GERD [12]. The aim of...