Managing Failed Anti-reflux Therapy

Although GERD was initially described in the early 19 century, it is essentially a c-sequence of our modern day largesse. Dietary factors and associated obesity have combined with as yet other unknown factors (e.g. a decrease in the prevalence of H. pylori?) to make GERD one of the most common diseases affecting western society. It is estimated that up to 20 million adults in the United States suffer from GERD, and treatment of these individuals consumes approximately $10 billion annually, the majority of it for prescription drugs used to manage the disease and its symptoms. Fortunately, despite challenges presented by co-factors resulting in GERD (diet, obesity, etc.), therapy of GERD is largely successful. However, even a low failure rate for a therapy used in the management of GERD still results in large numbers of affected patients because of the high prevalence of this disease. Use of a conservative estimate of a failure rate of 5% translates to 1 million ineffectively treated and unhappy patients. How to manage these patients is the subject of this book. Why is publication of this book important now? Several factors prompted us to work on this project. Mature results for proton pump inhibitor use are available,making this an appropriate time to review outcomes of PPI therapy of GERD. Similarly, mature results are now available for minimally invasive surgical therapy for GERD.

Gastroesophageal reflux disease (GERD) affects millions of people in western society. Since the introduction of laparoscopic techniques in the 1990s, it is now one of the most common indications for surgery.

This multiauthored text provides information on the pathophysiology of GERD, appropriate medical management, and proper indications for and performance of surgical and endoscopic procedures for GERD. Thousands of patients will experience inadequate relief from medical therapy or will develop complications from their procedures or recurrent or new symptoms afterwards; this text describes in detail the proper evaluation and management of such patients.

Beginning with an overview of the current understanding of the pathophysiology of GERD, the book moves onto new information regarding tissue susceptibility, the role of bile and digestive enzymes, and cyclic changes in LES tone. The next chapters are devoted to standard therapeutic options for GERD, including lifestyle changes, pharmacologic therapy, and surgery. In addition, newer endoscopic treatments, such as Stretta, Endocinch, injection of bulking agents, as well as others, are described. Subsequent chapters focus on the causes for failure of medical, endoscopic, and surgical therapies. The remainder of the text is a detailed examination of medical, endoscopic, and surgical remedies for these treatment failures.

This text is essential to any physician who manages patients with GERD, including internists, gastroenterologists, general surgeons, and thoracic surgeons.