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Wickramasinghe N, Devanarayana NM. Unveiling the intricacies: Insight into gastroesophageal reflux disease. World J Gastroenterol 2025; 31:98479. [PMID: 39777237 PMCID: PMC11684178 DOI: 10.3748/wjg.v31.i1.98479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 10/26/2024] [Accepted: 11/11/2024] [Indexed: 12/09/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) poses a substantial global health challenge, with prevalence rates exhibiting geographical variation. Despite its widespread recognition, the exact prevalence and associated risk factors remain elusive. This article comprehensively analyzed the global burden of GERD, shedding light on its risk factors, underlying pathophysiological mechanisms, current diagnostic modalities, evolving management strategies tailored to diverse patient profiles, and complex determinants contributing to treatment failures. A deeper comprehension of GERD is achieved by dissecting these intricate facets, paving the way for enhanced clinical management and improved patient outcomes.
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Affiliation(s)
- Nilanka Wickramasinghe
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo 00800, Western Province, Sri Lanka
| | - Niranga Manjuri Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Western Province, Sri Lanka
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Labenz J, Schoppmann SF. Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors. COMMUNICATIONS MEDICINE 2024; 4:200. [PMID: 39397153 PMCID: PMC11471847 DOI: 10.1038/s43856-024-00632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 10/07/2024] [Indexed: 10/15/2024] Open
Abstract
Proton pump inhibitors (PPIs) are the main treatment recommended and used for gastro-esophageal reflux disease (GERD). However, they fail to control symptoms in a substantial proportion of patients who have PPI-refractory GERD, which is defined as persistent symptoms attributable to objective findings of gastro-esophageal reflux. There remains a lack of dedicated guidelines to direct the management of these patients, some of whom could benefit greatly from surgical treatment. Too often patients remain long-term on ineffective treatment or stop treatment with lack of active review often resulting in their dissatisfaction going unnoticed. Also, concerns over efficacy and side effects of surgical procedures can be off-putting for both patients and physicians. It has been suggested that response to PPIs is predictive of surgical outcome. In this Perspective article we instead recommend that the key determinant should be whether symptoms are caused by GERD. We also discuss the traditional and newer surgical treatment options for people with PPI-refractory GERD.
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Affiliation(s)
- Joachim Labenz
- Refluxzentrum Siegerland, Siegen, Germany.
- Medical Faculty of Duisburg-Essen University, Essen, Germany.
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Palenzuela DL, Gee D, Petrusa E, Maltby A, Andrus S, Paranjape C. Hiatal hernia reporting: time to remove subjectivity? Surg Endosc 2024; 38:437-442. [PMID: 37985491 DOI: 10.1007/s00464-023-10562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The size of a hiatal hernia (HH) is a key determinant of the approach for surgical repair. However, endoscopists will often utilize subjective terms, such as "small," "medium," and "large," without any standardized objective correlations. The aim of this study was to identify HHs described using objective axial length measurements versus subjective size allocations and compare them to their corresponding manometry and barium swallow studies. METHODS AND PROCEDURES Retrospective chart reviews were conducted on 93 patients diagnosed endoscopically with HHs between 2017 and 2021 at Newton-Wellesley Hospital. Information was collected regarding their HH subjective size assessment, axial length measurement (cm), manometry results, and barium swallow readings. Linear regression models were used to analyze the correlation between the objective endoscopic axial length measurements and manometry measurements. Ordered logistic regression models were used to correlate the ordinal endoscopic and barium swallow subjective size allocations with the continuous axial length measurements and manometry measurements. RESULTS Of the 93 endoscopy reports, 42 included a subjective size estimate, 38 had axial length measurement, and 12 gave both. Of the 34 barium swallow reads, only one gave an objective HH size measurement. Axial length measurements were significantly correlated with the manometry measurements (R2 = 0.0957, p = 0.049). The endoscopic subjective size estimates were also closely related to the manometry measurements (R2 = 0.0543, p = 0.0164). Conversely, the subjective size estimates from barium swallow reads were not significantly correlated with the endoscopic axial length measurements (R2 = 0.0143, p = 0.366), endoscopic subjective size estimates (R2 = 0.0481, p = 0.0986), or the manometry measurements (R2 = 0.0418, p = 0.0738). Mesh placement was significantly correlated to pre-operative endoscopic axial length measurement (p = 0.0001), endoscopic subjective size estimate (p = 0.0301), and barium swallow read (p = 0.0211). However, mesh placement was not significantly correlated with pre-operative manometry measurements (0.2227). CONCLUSIONS Endoscopic subjective size allocations and objective axial length measurements are associated with pre-operative objective measurements and intra-operative decisions, suggesting both can be used to guide clinical decision making. However, including axial length measurements in endoscopy reports can improve outcomes reporting.
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Affiliation(s)
| | - Denise Gee
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Charudutt Paranjape
- Massachusetts General Hospital, Boston, MA, USA
- Newton-Wellesley Hospital, Newton, MA, USA
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The American Foregut Society Clinical Practice Committee TIF Working Group, Brewer Gutierrez OI, Choi D, Hejazi R, Samo S, Tran MN, Chang KJ, Ihde G, Bell R, Nguyen NT. American Foregut Society White Paper on Transoral Incisionless Fundoplication. FOREGUT: THE JOURNAL OF THE AMERICAN FOREGUT SOCIETY 2023; 3:242-254. [DOI: 10.1177/26345161231170788] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
Gastroesophageal reflux disease (GERD) is a chronic disease on a spectrum that has an array of management options ranging from lifestyle changes, acid suppressive therapy to laparoscopic anti-reflux surgery (LARS). Transoral incisionless fundoplication (TIF) is an endoscopic procedure in the management of GERD that re-establishes and augments the gastroesophageal flap valve (GEFV). TIF is appropriate for patients that do not have a hiatal hernia greater than 2 cm. Patients with a hiatal hernia greater than 2 cm have the option to have either a conventional LARS (laparoscopic hiatal hernia repair with complete or partial fundoplication) or a concomitant laparoscopic hiatal hernia repair with TIF, known as concomitant TIF (cTIF). This white paper summarizes the published outcome data for TIF 2.0 and cTIF to date and outline the best practice approaches including patient assessment, selection, and management for TIF and cTIF.
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Affiliation(s)
| | | | - David Choi
- Larkin Community Hospital, South Miami, FL, USA
| | - Reza Hejazi
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Salih Samo
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Glenn Ihde
- Matagorda Regional Medical Center, Bay City, TX, USA
| | - Reginald Bell
- Institute of Esophageal and Reflux Surgery, Englewood, CO, USA
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Snow GE, Dbouk M, Akst LM, Ihde G, Zarnegar R, Janu P, Murray M, Eskarous H, Sohagia A, Dhar SI, Irene Canto M. Response of Laryngopharyngeal Symptoms to Transoral Incisionless Fundoplication in Patients with Refractory Proven Gastroesophageal Reflux. Ann Otol Rhinol Laryngol 2022; 131:662-670. [PMID: 34378427 DOI: 10.1177/00034894211037414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with laryngopharyngeal reflux (LPR) symptoms may not respond to proton pump inhibitors (PPI) if they have an alternative laryngeal diagnosis or high-volume reflux. Transoral incisionless fundoplication (TIF) or TIF with concomitant hiatal hernia repair (cTIF) are effective in decreasing symptoms of gastroesophageal reflux disease (GERD) but are not well studied in patients with LPR symptoms. This prospective multicenter study assessed the patient-reported and clinical outcomes after TIF/cTIF in patients with LPR symptoms and proven GERD. METHODS Patients with refractory LPR symptoms (reflux symptom index [RSI] > 13) and with erosive esophagitis, Barrett's esophagus, and/or pathologic acid reflux by distal esophageal pH testing were evaluated before and after a minimum of 6 months after TIF/cTIF. The primary outcome was normalization of RSI. Secondary outcomes were >50% improvement in GERD-Health-Related Quality of Life (GERD-HRQL), normalization of esophageal acid exposure time, discontinuation of PPI, and patient satisfaction. RESULTS Forty-nine patients had TIF (n = 26) or cTIF (n = 23) with at least 6 months follow-up. Mean pre- and post TIF/cTIF RSI were 23.6 and 5.9 (mean difference: 17.7, P < .001). Post TIF/cTIF, 90% of patients had improved GERD-HQRL score, 85% normalized RSI, 75% normalized esophageal acid exposure time, and 80% discontinued PPI. No serious procedure-related adverse events occurred. Patient satisfaction was 4% prior to TIF/cTIF and 73% after TIF/cTIF (P < .001). CONCLUSION In patients with objective evidence of GERD, TIF, or cTIF are safe and effective in controlling LPR symptoms as measured by normalization of RSI and improvement in patient satisfaction after TIF/cTIF. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Grace E Snow
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamad Dbouk
- Division of Gastrointestinal and Liver Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lee M Akst
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Glenn Ihde
- Department of General Surgery, The Matagorda Regional Medical Group, Bay City, TX, USA
| | | | - Peter Janu
- Department of Surgery, Fox Valley Surgical Associates, Appleton, WI, USA
| | - Michael Murray
- Department of Surgery, Northern Nevada Medical Center, Sparks, NV, USA
| | - Hany Eskarous
- Department of Medicine, Easton Hospital, Easton, PA, USA
| | - Amit Sohagia
- Department of Medicine, Easton Hospital, Easton, PA, USA
| | - Shumon I Dhar
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marcia Irene Canto
- Division of Gastroenterology, Department of Medicine and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Maselli DB, Abusaleh R, Trad KS, Lopez-Nava G, Turró R, Abu Dayyeh BK. Feasibility of a single endoscopic plication procedure for the treatment of gastroesophageal reflux disease and obesity. Endoscopy 2022; 54:E203-E204. [PMID: 33979860 DOI: 10.1055/a-1481-7844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Daniel B Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rami Abusaleh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karim S Trad
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gontrand Lopez-Nava
- Bariatric Endoscopy Unit, Madrid Sanchinarro University Hospital, Madrid, Spain
| | - Román Turró
- Unidad de Endoscopia, Centro Médico Teknon, Barcelona, Spain
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Snow G, Dhar SI, Akst LM. How to Understand and Treat Laryngopharyngeal Reflux. Gastroenterol Clin North Am 2021; 50:871-884. [PMID: 34717876 DOI: 10.1016/j.gtc.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laryngopharyngeal reflux (LPR) is frustrating, as symptoms are nonspecific and diagnosis is often unclear. Two main approaches to diagnosis are empiric treatment trials and objective reflux testing. Initial empiric trial of Proton pump inhibitors (PPI) twice daily for 2-3 months is convenient, but risks overtreatment and delayed diagnosis if patient complaints are not from LPR. Dietary modifications, H2-antagonists, alginates, and fundoplication are other possible LPR treatments. If objective diagnosis is desired or patients' symptoms are refractory to empiric treatment, pH testing with/without impedance should be considered. Additionally, evaluation for non-reflux etiologies of complaints should be performed, including laryngoscopy or videostroboscopy.
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Affiliation(s)
- Grace Snow
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
| | - Shumon I Dhar
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA
| | - Lee M Akst
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, 6th Floor, Baltimore, MD 21287, USA.
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Benias PC, Kumbhari V, Kumta NA, Sethi A, D’Souza LS, Tyberg A, Brewer Gutierrez O, Miller LS, Carr-Locke DL, Khashab MA. Single session per oral endoscopic myotomy and trans oral incisionless fundoplication - can we prevent reflux in patients with achalasia? Endosc Int Open 2021; 9:E828-E835. [PMID: 34079863 PMCID: PMC8159615 DOI: 10.1055/a-1395-5667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Background and study aims The rate of gastroesophageal reflux disease (GERD) after per oral endoscopic myotomy (POEM) is concerning. Endoscopic anti-reflux methods, such as Trans Oral Incisionless Fundoplication (TIF), are crucial for the long-term success of POEM, especially if they can be performed in the same session. Methods We completed a proof-of-concept canine pilot study (n = 6) to assess safety and feasibility of POEM and TIF in a single session (POEM-TIF). Subsequently, POEM-TIF was also performed in patients with achalasia (n = 5). Herein, we report on the safety, technical and clinical success of the first-in-human cases with symptom follow-up at 1, 3 and 6 months and pH testing at 6 months. Results POEM was completed successfully in six canines (3 anterior and 3 posterior myotomies), followed by TIF in the same session. Necropsy and extensive testing demonstrated no evidence of mucosal injury and no leaks. The reconstructed valve was 220 to 240 degrees, 3 to 4 cm in length, and resulted in concomitant esophageal lengthening (2-5 cm). Using similar principles, the first-in-human cases were performed without intraprocedural or delayed adverse events. pH testing at 6 months showed that four of five patients had no evidence of GERD (DeMeester > 14.72), and in one case, there was evidence of esophagitis. Conclusions Single session POEM-TIF appears to be safe and feasible. Early clinical human data suggests that it may be able to reduce post POEM GERD, however the additional secondary benefits such as lengthening and straightening of the esophagus, may prove to be equally important for the long-term success of POEM.
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Affiliation(s)
- Petros C. Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| | - Nikhil A. Kumta
- Division of Gastroenterology and Hepatology, Mount Sinai, New York, New York, United States.
| | - Amrita Sethi
- Division of Gastroenterology, Columbia University Medical Center, New York, New York.
| | - Lionel S. D’Souza
- Division of Gastroenterology and hepatology, Stony Brook School of Medicine, East Setauket, New York, United States
| | - Amy Tyberg
- Department of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States.
| | - Olaya Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| | - Larry S. Miller
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States
| | - David L. Carr-Locke
- Division of Gastroenterology and Hepatology, Weil Cornell School of Medicine, New York Hospital, New York, New York, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
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Choi AY, Roccato MK, Samarasena JB, Kolb JM, Lee DP, Lee RH, Daly S, Hinojosa MW, Smith BR, Nguyen NT, Chang KJ. Novel Interdisciplinary Approach to GERD: Concomitant Laparoscopic Hiatal Hernia Repair with Transoral Incisionless Fundoplication. J Am Coll Surg 2021; 232:309-318. [PMID: 33346082 DOI: 10.1016/j.jamcollsurg.2020.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transoral incisionless fundoplication (TIF) is an endoscopic alternative for the treatment of GERD. However, TIF does not address the hiatal hernia (HH). We present a novel approach with a laparoscopic HH repair followed by same-session TIF, coined concomitant transoral incisionless fundoplication (cTIF). The aim of this study was to assess the efficacy, safety, and feasibility of cTIF in a collaborative approach between Gastroenterology and surgery. STUDY DESIGN Patients with confirmed GERD and >2 cm HH who underwent cTIF between 2018 and 2020 were included. Symptoms were assessed using the Reflux Disease Questionnaire, GERD Health-Related Quality of Life Index, and the Reflux Symptom Index pre and post cTIF. One-way ANOVA and paired samples t-test were used for statistical analysis. RESULTS Sixty patients underwent cTIF (53% were men, mean age was 59.3 years) with 100% technical success. Mean ± SD HH measurement on endoscopy was 2.9 ± 1.5 cm. Scores on Reflux Disease Questionnaire for symptom frequency and symptom severity improved significantly from before to 6 months after cTIF (17.4 to 4.72; p < 0.01 and 16.7 to 4.56; p < 0.05, respectively). According to the GERD Health-Related Quality of Life Index, significant decreases were seen post cTIF in heartburn (23.26 to 7.37; p < 0.01) and regurgitation (14.26 to 0; p = 0.05). Reflux Symptom Index similarly decreased after cTIF (17.7 to 8.1 post cTIF; p < 0.01). Mean DeMeester score decreased from 43.7 to 4.9 and acid exposure time decreased from 12.7% to 1.28% post cTIF (p = 0.06). CONCLUSIONS We present a novel multidisciplinary approach to GERD using a combined endoscopic and surgical approach with close collaboration between Gastroenterology and surgery. Our results suggest that cTIF is safe and effective in reducing reflux symptoms in a large spectrum of GERD patients.
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Affiliation(s)
- Alyssa Y Choi
- HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA; Departments of Medicine, University of California, Irvine Medical Center, Orange, CA.
| | - Mary Kathryn Roccato
- HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA; Departments of Medicine, University of California, Irvine Medical Center, Orange, CA
| | - Jason B Samarasena
- HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA; Departments of Medicine, University of California, Irvine Medical Center, Orange, CA
| | - Jennifer M Kolb
- HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA; Departments of Medicine, University of California, Irvine Medical Center, Orange, CA
| | - David P Lee
- HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA; Departments of Medicine, University of California, Irvine Medical Center, Orange, CA
| | - Robert H Lee
- HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA; Departments of Medicine, University of California, Irvine Medical Center, Orange, CA
| | - Shaun Daly
- Departments of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Marcelo W Hinojosa
- Departments of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Brian R Smith
- Departments of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Ninh T Nguyen
- Departments of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Kenneth J Chang
- HH Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA; Departments of Medicine, University of California, Irvine Medical Center, Orange, CA
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Banting SP, Badgery HE, Read M, Mashimo H. Rethinking gastroesophageal reflux disorder. Ann N Y Acad Sci 2020; 1482:177-192. [PMID: 32875572 DOI: 10.1111/nyas.14478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common clinical condition for which our understanding has evolved over the past decades. It is now considered a cluster of phenotypes with numerous anatomical and physiological abnormalities contributing to its pathophysiology. As such, it is important to first understand the underlying mechanism of the disease process for each patient before embarking on therapeutic interventions. The aim of our paper is to highlight the mechanisms contributing to GERD and review investigations and interpretation of these results. Finally, the paper reviews the available treatment modalities for this condition, ranging from medical intervention, endoscopic options through to surgery and its various techniques.
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Affiliation(s)
- Samuel P Banting
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Henry E Badgery
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, the University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hiroshi Mashimo
- Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
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11
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Gisi C, Wang K, Khan F, Reicher S, Hou L, Fuller C, Sattler J, Eysselein V. Efficacy and patient satisfaction of single-session transoral incisionless fundoplication and laparoscopic hernia repair. Surg Endosc 2020; 35:921-927. [DOI: 10.1007/s00464-020-07796-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022]
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Danilova DA, Bazaev AV, Gorbunova LI. [Current aspects of surgical treatment of gastro-esophageal reflux disease]. Khirurgiia (Mosk) 2020:89-94. [PMID: 32105262 DOI: 10.17116/hirurgia202002189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastroesophageal reflux disease (GERD) is characterized by abnormal reflux of gastric content into the esophagus, pharynx, respiratory tract and oral cavity. In recent years, there has been a significant increase of the incidence of this disease, that significantly aggravates quality of life of the population. The 'gold standard' for treating GERD is anti-secretory therapy with proton pump inhibitors (PPIs). However, up to 40% of patients are unresponsive to PPIs even after dose adjustment. Advantages and disadvantages of modern surgical approaches for this pathology are reviewed. Laparoscopic fundoplication including Nissen (360°), Toupet (270°) and Dor procedures (180°) is the most common anti-reflux operation. In addition, new alternative surgical options are also discussed. For example, these are minimally invasive methods such as LINX reflux control system, electrical stimulation of the lower esophageal sphincter and transoral incisionless fundoplication (TIF). These methods are less aggressive and have less side effects. A comparative assessment of modern methods of surgical treatment of GERD is made.
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Affiliation(s)
- D A Danilova
- Privolzhsky Research Medical University of the Ministry of Health of the Russia, Nizhniy Novgorod, Russia
| | - A V Bazaev
- Privolzhsky Research Medical University of the Ministry of Health of the Russia, Nizhniy Novgorod, Russia
| | - L I Gorbunova
- Privolzhsky Research Medical University of the Ministry of Health of the Russia, Nizhniy Novgorod, Russia
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Janu P, Shughoury AB, Venkat K, Hurwich D, Galouzis T, Siatras J, Streeter D, Korman K, Mavrelis G, Mavrelis P. Laparoscopic Hiatal Hernia Repair Followed by Transoral Incisionless Fundoplication With EsophyX Device (HH + TIF): Efficacy and Safety in Two Community Hospitals. Surg Innov 2019; 26:675-686. [PMID: 31431138 PMCID: PMC6843624 DOI: 10.1177/1553350619869449] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The TIF (transoral incisionless fundoplication) 2.0 procedure is indicated for patients with a hiatal hernia less than 2 cm. Many patients with gastroesophageal reflux disease (GERD) require hiatal hernia repair. This study examined the safety and efficacy when repairing defects in 2 anatomical structures (hiatus and lower esophageal sphincter) in a concomitant set of procedures in patients with hiatal hernias between 2 and 5 cm. Methods. Prospective data were collected from 99 patients who underwent hiatal hernia repair followed immediately by the TIF procedure (HH + -TIF). GERD-HRQL (Health-Related Quality of Life), RSI (Reflux Symptom Index), and GERSS (Gastroesophageal Reflux Symptom Score) questionnaires were administered before the procedure and mailed at 6 and 12 months. Results. Ninety-nine patients were enrolled, and all were symptomatic on PPI medications with hiatal hernias between 2 and 5 cm. Overall baseline GERD-HRQL scores indicated daily bothersome symptoms. At 12-month follow-up, median GERD-HRQL scores improved by 17 points, indicating that subjects had no bothersome symptoms. The median GERSS scores decreased from 25.0 at baseline to 1.0 and 90% of subjects reported having effective symptom control (score <18) at 12 months. Seventy-seven percent of subjects reported effective control of laryngopharyngeal reflux (LPR) symptoms at 12 months with an RSI score of 13 or less. At 12 months, 74% of subjects reported that they were not using proton pump inhibitors. All measures were statistically improved at P < .05. There were no adverse effects reported. Conclusion. HH + TIF provides significant symptom control for heartburn and regurgitation with no long-term dysphagia or gas bloat normally associated with traditional antireflux procedures. Most patients reported durable symptom control and satisfaction with health condition at 12 months.
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Affiliation(s)
- Peter Janu
- Affinity Health Systems Appleton, Chilton, WI, USA
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Joseph SJ, Ebstein AMM, Sapp A. Effectiveness of transoral incisionless fundoplication compared to Toupet fundoplication for chronic or refractory gastroesophageal reflux disease: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:507-512. [PMID: 30973524 DOI: 10.11124/jbisrir-2017-003893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
REVIEW OBJECTIVE/QUESTION The objective of this review is to determine which 270-degree fundoplication procedure has a better outcome in patients with chronic or refractory gastroesophageal reflux disease (GERD). This review will identify the fundoplication approach for chronic or refractory GERD that provides better reflux control with minimal post-procedure complications.The question of this review is: what is the effectiveness of transoral incisionless fundoplication compared to Toupet fundoplication in adult patients with chronic or refractory GERD?
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Affiliation(s)
- Simi Jesto Joseph
- GI Solutions of Illinois, Chicago, USA
- The Center for Translational Research: a Joanna Briggs Institute Centre of Excellence
| | - Ann Marie Mazzella Ebstein
- Memorial Sloan Kettering Cancer Center, New York, USA
- The Center for Translational Research: a Joanna Briggs Institute Centre of Excellence
| | - Alysha Sapp
- Texas Christian University, Fort Worth, USA
- The Center for Translational Research: a Joanna Briggs Institute Centre of Excellence
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Abstract
PURPOSE OF REVIEW Nearly, a third of patients with medically refractory gastroesophageal reflux disease (GERD) will desire an additional nonsurgical treatment option. Recently, endoscopic therapy has been reintroduced as a minimally invasive antireflux barrier treatment, after addressing prior efficacy and safety concerns. Over the last two decades, additional experience and new technologies have resulted in devices and protocols with favorable short-term outcomes and safety profiles. The current literature in endoscopic antireflux therapies covers new devices, long-term follow-up data and further safety experience. This review discusses the endoscopic antireflux devices on the market and most recent studies in this area. RECENT FINDINGS Quality of life and reflux symptom score improvement is observed in 73-90% of patients through a 36-48 month follow-up period, with 41-77% remaining off all reflux medicines. Composite data from several thousand cases indicate a low rate (0.93-2.4%) of serious complications and no late adverse effects, including gas-bloat syndrome. SUMMARY In this review, we describe the four endoscopic antireflux devices on market and summarize the current data in the literature. The short and long-term data demonstrate durable symptom improvement and favorable safety profile. Endoscopic antireflux treatment should be considered in the management of GERD.
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Chimukangara M, Jalilvand AD, Melvin WS, Perry KA. Long-term reported outcomes of transoral incisionless fundoplication: an 8-year cohort study. Surg Endosc 2018; 33:1304-1309. [PMID: 30167944 DOI: 10.1007/s00464-018-6403-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transoral incisionless fundoplication (TIF) offers an endoscopic approach to the treatment of gastroesophageal reflux disease (GERD). Controlled trials have demonstrated the short-term efficacy of this procedure, but long-term follow-up studies are lacking. The objective of this study was to evaluate the long-term impact of TIF on disease-specific quality of life and antisecretory medication use. METHODS We performed retrospective cohort study of all patients undergoing TIF between 2007 and 2014 in a large academic medical center. Reflux symptoms and quality of life were assessed using the gastroesophageal reflux disease health-related quality of life (GERD-HRQL) questionnaire at baseline, short-term, and long-term follow-up. RESULTS Fifty-seven patients with a median age of 46 (37-59) years and an average BMI of 28.8 ± 4.9 kg/m2 underwent TIF during the study period. Sixty percent of the patients were female, and all were taking a PPI at least daily. At a median follow-up interval of 97 months, twelve patients had undergone subsequent laparoscopic antireflux surgery (LARS). Of those who had not, 23 had complete long-term follow-up data for analysis and were included in the study. Seventy-three percent reported daily acid-reducing medication use, and the median GERD-HRQL score was 10 (6-14) compared to 24 (15-28) at baseline (p < 0.01). Seventy-eight percent of these patients expressed satisfaction or neutral feelings about their GERD management. There were no significant differences in the baseline characteristics of patients who underwent LARS during the study period and those who did not. CONCLUSIONS This study demonstrates that TIF can produce durable improvements in disease-specific quality of life in some patients with symptomatic GERD. The majority of patients resumed daily PPI therapy during the study period, but with significantly improved GERD-HRQL scores compared to baseline and increased satisfaction with their medical condition.
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Affiliation(s)
| | | | - W Scott Melvin
- Department of Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kyle A Perry
- Department of Surgery, The Ohio State University, Columbus, OH, USA.
- Division of General & Gastrointestinal Surgery, 410 W. 10th Ave, Columbus, OH, 43210, USA.
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Endoscopic Fundoplication: Effectiveness for Controlling Symptoms of Gastroesophageal Reflux Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 12:180-185. [PMID: 28296655 DOI: 10.1097/imi.0000000000000351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Transoral incisionless fundoplication (TIF) is a completely endoscopic approach to treat gastroesophageal reflux disease (GERD). We previously reported our initial results demonstrating safety and early effectiveness. We now present an updated experience describing outcomes with longer follow-up. METHODS For a three-year period, TIF procedures were performed on 80 patients. Preoperative workup routinely consisted of contrast esophagram and manometry. PH testing was reserved for patients with either atypical symptoms or typical symptoms unresponsive to proton-pump inhibitors (PPIs). Heartburn severity was longitudinally assessed using the GERD health-related quality of life index. Safety analysis was performed on all 80 patients, and an effectiveness analysis was performed on patients with at least 6-month follow-up. RESULTS Mean procedure time was 75 minutes. There were seven (8.75%) grade 2 complications and one (1.25%) grade 3 complication (aspiration pneumonia). The median length of stay was 1 day (mean, 1.4). Forty-one patients had a minimum of 6-month of follow-up (mean, 24 months; range, 6-68 months). The mean satisfaction scores at follow-up improved significantly from baseline (P < 0.001). Sixty-three percent of patients had completely stopped or reduced their PPI dose. Results were not impacted by impaired motility; however, the presence of a small hiatal hernia or a Hill grade 2/4 valve was associated with reduced GERD health-related quality of life scores postoperatively. CONCLUSIONS At a mean follow-up of 24 months, TIF is effective. Although symptoms and satisfaction improved significantly, many patients continued to take PPIs. Future studies should focus on longer-term durability and comparisons with laparoscopic techniques.
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Fernando HC. Endoscopic fundoplication: patient selection and technique. J Vis Surg 2017; 3:121. [PMID: 29078681 DOI: 10.21037/jovs.2017.08.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/02/2017] [Indexed: 11/06/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common condition that places a significant burden on the healthcare system. Additionally, there have been concerns raised about potential risks of long-term proton pump inhibitors. Laparoscopic anti-reflux surgery is currently the gold standard option for patients when surgery is planned. However, there continues to be interest in an endoscopic, alternative to laparoscopic surgery. Transoral incisionless fundoplication (TIF) is being increasingly utilized for such patients. We review the indications, patient selection and technique for this procedure. A video of the procedure, which we previously published on CTSNet is also attached.
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Affiliation(s)
- Hiran C Fernando
- Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, VA, USA
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Ebright MI, Sridhar P, Litle VR, Narsule CK, Daly BD, Fernando HC. Endoscopic Fundoplication. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael I. Ebright
- Section of Thoracic Surgery, Columbia University Medical Center, New York, NY USA
| | - Praveen Sridhar
- Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Virginia R. Litle
- Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Chaitan K. Narsule
- Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Benedict D. Daly
- Division of Thoracic Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA USA
| | - Hiran C. Fernando
- Section of Thoracic Surgery, Inova Fairfax Hospital, Fairfax, VA USA
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