Pathological gastro-oesophageal reflux is multifactorial chronic disorder
with increasing prevalence. Incompetence of the physiological anti-reflux mechanisms
at the gastro-oesophageal junction results in this reflux and the cardinal symptoms are
heartburn and regurgitation as well as a host of extra-oesophageal manifestations.
Severe chronic GORD results in prolonged oesophageal acid exposure and to the
development erosive esophagitis, deep ulcers, strictures and Barrett's oesophagus.
The goal of treatment for GORD is to control symptom control, to heal any
oesophagitis and to improve the quality of life. Acid suppression represents the
mainstay of medical treatment for GORD. Proton pump inhibitors provide symptomatic
relief and healing of erosive oesophagitis in over 80% of patients. Surgical intervention
aims to provide a curative reconstruction of the anti-reflux barrier at the GOJ and
should be considered in patients with continuing or drug-refractory GORD. Anti-reflux
surgery has shown greater resolution of reflux symptoms and oesophagitis compared to
medical therapy. Currently laparoscopic total or partial fundoplication is the gold
standard for surgical intervention. The most common post-operative complications are
gaseous bloating, dysphagia and diarrhoea.
A number of novel therapies, such as the LINX and Esophyx, have shown promise in
achieving good symptomatic relief by correcting pathological reflux and possessing a
better side-effect profile than surgical fundoplication.
Keywords: GORD, Reflux, Hiatus hernia, Oesophagitis, Oesophageal strictures,
pH metry, Impedance, Proton pump inhibitors, Fundoplication, Oesophageal
lengthening.
