Document Detail

Review article: approaches to the long-term management of adults with GERD-proton pump inhibitor therapy, laparoscopic fundoplication or endoscopic therapy?
MedLine Citation:
PMID:  14725577     Owner:  NLM     Status:  MEDLINE    
The goals of gastro-oesophageal reflux disease (GERD) treatment are to control symptoms, heal the injured oesophageal mucosa, and prevent complications. Pharmacological therapy is effective in producing acute symptom relief and mucosal healing, as well as the long-term maintenance of remission. Proton pump inhibitors are the mainstay of GERD therapy. However, the need for daily administration, failure to provide complete symptom relief and costs of these agents may limit their use in some patients, prompting a consideration of alternative treatment strategies. Laparoscopic fundoplication may achieve symptom relief and healing of the oesophagitis in these individuals, but its invasiveness, cost and inherent surgical risks have created an interest in endoscopic therapies for GERD, with several emerging during the past few years. These interventions may either be viewed as an alternative therapy or as 'bridge' therapy, with patients still choosing to be treated with acid anti-secretory drugs or fundoplication if the endoscopic procedure fails to provide adequate symptom relief or if symptoms recur. Patient selection is critical for the success of fundoplication as well as endoscopic procedures, with ideal candidates being those with well-established endoscopically documented GERD, abnormal pH monitoring, normal oesophageal motility studies, and who have experienced at least partial symptom relief with proton pump inhibitor therapy. Hiatal hernia is not a contra-indication to fundoplication, while endoscopic intervention is best suited for those with a hiatal hernia of less than 3 cm in length. The long-term efficacy, cost-effectiveness, and impact of endoscopic procedures on extra-oesophageal manifestations of GERD and risk for GERD-related complications has not been determined.
J W Freston; G Triadafilopoulos
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  19 Suppl 1     ISSN:  0269-2813     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-01-16     Completed Date:  2004-04-16     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  35-42     Citation Subset:  IM    
University of Connecticut Health Center, Farmington Avenue, Farmington, CT 06030-1111, USA.
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MeSH Terms
Antacids / therapeutic use
Endoscopy, Gastrointestinal / methods*
Fundoplication / methods*
Gastroesophageal Reflux / therapy*
Gastrointestinal Agents / therapeutic use*
Heartburn / etiology
Laparoscopy / methods*
Proton Pumps / antagonists & inhibitors*
Risk Factors
Reg. No./Substance:
0/Antacids; 0/Gastrointestinal Agents; 0/Proton Pumps

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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