Gastroesophageal reflux: medical and surgical management.

The assessment of gastroesophageal reflux requires a carefully taken history and appropriate selection of the relevant diagnostic tests from among the many such tests available. Gastroesophageal reflux is generally produced by an imbalance between the intragastric pressure on the one hand and the degree of competence of the lower esophageal sphincter on the other. Medical management incorporates measures designed to promote gastric emptying, augment the resting tone of the lower esophageal sphincter, and favorably alter the nature of the refluxed material by dietary and pharmacological means. The surgical techniques commonly applied for the prevention of gastroesophageal reflux aim to restore an intraabdominal segment of esophagus and to augment sphincter competence by either a partial or complete fundoplication. Comparison of results obtained with various operations is difficult, as assessment is often imprecise, subjective, and partisan. Development of a uniform method of postoperative assessment, free from observed bias, would be a major advance.