Department of Surgery, Stanford University, Alway Building, Room M121, 300 Pasteur Drive, MC 5115, Stanford, CA, 94305, USA.
J Gastrointest Surg. 2017 Sep;21(9):1544-1552. doi: 10.1007/s11605-017-3439-5. Epub 2017 Jun 16.
Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disorder of the esophagus. It is a chronic, progressive disorder that presents most typically with heartburn and regurgitation and atypically with chest pain, dysphagia, chronic cough, globus, or sore throat. The mainstay for diagnosis and characterization of the disorder is esophagoduodenoscopy (EGD), high-resolution esophageal manometry, and symptom-associated ambulatory esophageal pH impedance monitoring. Additional studies that can be useful in certain clinical presentations include gastric scintigraphy and oral contrast upper gastrointestinal radiographic series.
Refractory GERD can be surgically managed with various techniques. In obese individuals, laparoscopic Roux-en-Y gastric bypass should be considered due to significant symptom improvement and lower incidence of recurrent symptoms with weight loss. Otherwise, laparoscopic Nissen fundoplication is the preferred surgical technique for treatment of this disease with concomitant hiatal hernia repair when present for either procedure. The short-term risks associated with these procedures include esophageal or gastric injury, pneumothorax, wound infection, and dysphagia. Emerging techniques for treatment of this disease include the Linx Reflux Management System, EndoStim LES Stimulation System, Esophyx® and MUSE™ endoscopic fundoplication devices, and the Stretta endoscopic ablation system. Outcomes after surgical management of refractory GERD are highly dependent on adherence to strict surgical indications and appropriate patient-specific procedure selection.
胃食管反流病（GERD）是最常见的食管胃肠道疾病。它是一种慢性、进行性疾病，最典型的表现是烧心和反流，不典型的表现是胸痛、吞咽困难、慢性咳嗽、异物感或咽喉痛。诊断和疾病特征的主要方法是食管胃十二指肠镜检查（EGD）、高分辨率食管测压和症状相关的动态食管 pH 阻抗监测。在某些特定临床表现中，还可以进行其他一些有用的研究，包括胃闪烁扫描和口服对比上胃肠道 X 线系列。
难治性 GERD 可以通过各种技术进行手术治疗。对于肥胖者，由于体重减轻可显著改善症状，且复发症状发生率较低，应考虑腹腔镜 Roux-en-Y 胃旁路手术。否则，腹腔镜 Nissen 胃底折叠术是治疗该病的首选手术技术，对于同时存在食管裂孔疝的患者应同时进行修补。这些手术的短期风险包括食管或胃损伤、气胸、伤口感染和吞咽困难。该疾病的新兴治疗技术包括 Linx 反流管理系统、EndoStim LES 刺激系统、Esophyx®和 MUSE™内镜胃底折叠术设备，以及 Stretta 内镜消融系统。难治性 GERD 手术后的结果高度取决于严格遵守手术适应证和选择适当的患者特定手术程序。
