Nicolau Alexandru Eugen, Lobonţiu Adrian, Constantinoiu Silviu
Chirurgia (Bucur). 2018 Jan-Feb;113(1):70-82. doi: 10.21614/chirurgia.113.1.70.
GERD has become one of the most frequent pathology of the upper GI tract. It is a spectrum disease and is a progressive disease as well. Serious and severe complications are possible. The mainstream therapy in most of the patients is the medical therapy with PPI's. The most severe cases with an impaired LES (Lower Esophageal Sphincter) function as well as important anatomical disruptions are of surgical indication, the gold standard being laparoscopic fundoplication, an elective therapy with long term follow up outcomes at the expense of de novo symptoms associated with fundoplications in general. 30% to 40% of the patients are PPI refractory with partial symptom control, but they are not willing to go for the laparoscopic fundoplication because of the invasive character and because of potential postfundoplications syndromes. There is a "treatment gap" for these patients with GERD. For a well selected patient population with GERD, with mild forms of the disease, without complications and without major anatomical disruptions (patients with small hiatal hernias), patients who are refractory on PPI medication, there are today new alternative therapies, minimally invasive. These therapies are less aggressive and basically with no side effects or new onset symptoms that Laparoscopic Fundoplications will give. These are endoscopic therapies which improve the LES function: Stretta utilizes radiofrequence therapy, a novel technique describes mucosal resection at the level of the cardia, while a partial fundoplication from within the stomach can be realized with EsophyX, Muse or Gerd-X. Form all these procedures, EsophyX is the most advanced with more than 20,000 patients treated worldwide, with good clinical outcomes and with no de novo symptoms. The laparoscopic techniques treat hiatal hernias larger than 2 cm. Linx utilizes a magnetic ring at the LES level. EndoStim utilizes electrodes in order to stimulate the LES muscle. These procedures are effective on short term and there are few patients treated with Linx or EndoStim. More research for Linx and EndoStim is necessary with randomized clinical trials, with improvement of the devices and with long term follow up.
胃食管反流病（GERD）已成为上消化道最常见的病症之一。它是一种谱系疾病，也是一种进行性疾病。严重并发症有可能发生。大多数患者的主流治疗方法是使用质子泵抑制剂（PPI）进行药物治疗。对于食管下括约肌（LES）功能受损以及存在重要解剖结构破坏的最严重病例，具有手术指征，金标准是腹腔镜胃底折叠术，这是一种选择性治疗方法，长期随访结果良好，但通常会出现与胃底折叠术相关的新发症状。30%至40%的患者对PPI治疗无效，症状仅得到部分控制，但由于其侵入性以及潜在的胃底折叠术后综合征，他们不愿意接受腹腔镜胃底折叠术。这些GERD患者存在“治疗缺口”。对于精心挑选的GERD患者群体，即病情较轻、无并发症且无重大解剖结构破坏（小裂孔疝患者）、对PPI药物治疗无效的患者，如今有了新的替代疗法，即微创疗法。这些疗法的侵袭性较小，基本上没有腹腔镜胃底折叠术会带来的副作用或新发症状。这些是改善LES功能的内镜治疗方法：Stretta利用射频疗法，一种描述在贲门水平进行黏膜切除的新技术，而通过EsophyX、Muse或Gerd-X可以在胃内实现部分胃底折叠术。在所有这些手术中，EsophyX最为先进，全球已治疗超过20000例患者，临床效果良好且无新发症状。腹腔镜技术用于治疗大于2厘米的裂孔疝。Linx在LES水平使用磁环。EndoStim利用电极刺激LES肌肉。这些手术在短期内有效，但接受Linx或EndoStim治疗的患者较少。有必要对Linx和EndoStim进行更多的随机临床试验研究，改进设备并进行长期随访。
