What is gastroesophageal reflux?
Gastroesophageal reflux disease (GERD) is the pathological return of gastric —and sometimes duodenal— content into the esophagus, to a degree that causes troublesome symptoms and/or mucosal injury (esophagitis).
It is mainly due to dysfunction of the lower esophageal sphincter, often together with a hiatal hernia.
How common is it?
It is among the most common digestive disorders: an estimated 10–20% of adults in Western countries are affected. Predisposing factors include obesity, hiatal hernia, smoking, pregnancy and certain dietary habits.
How does it present?
Typical and extra-esophageal symptoms include:
- Retrosternal burning (heartburn), often after meals or lying down.
- Regurgitation of acid content, sour or bitter taste.
- Dysphagia, sensation of a lump, painful swallowing.
- Chronic cough, hoarseness, laryngitis, asthma-like symptoms, dental erosion.
How is it diagnosed?
With typical symptoms the diagnosis is often clinical. When documentation or pre-operative assessment is needed:
- Upper GI endoscopy: grades esophagitis (Los Angeles classification) and excludes Barrett's esophagus or malignancy.
- 24-hour pH-impedance monitoring: the reference standard for objective confirmation of reflux.
- High-resolution manometry: assesses motility and excludes achalasia before surgery.
What are the complications?
Chronic, uncontrolled reflux can lead to:
- Esophagitis and, less often, peptic ulcer or esophageal stricture.
- Barrett's esophagus: replacement of normal lining with intestinal-type metaplasia — a precancerous condition requiring endoscopic surveillance.
- An increased, although in absolute terms low, risk of esophageal adenocarcinoma.
Modern treatment options
Management is stepwise: it starts with lifestyle and medication and progresses to surgery when there is a clear indication. The surgical option is individualised based on esophageal function.
Lifestyle & medical therapy
The foundation of treatment: weight loss, avoiding late/fatty meals, smoking cessation, head-of-bed elevation, combined with proton pump inhibitors (PPIs) to control acid.
Laparoscopic Nissen fundoplication
The classic anti-reflux operation: the gastric fundus is wrapped 360° around the lower esophagus, restoring the anti-reflux barrier. Indicated for refractory disease or dependence on medication.
Partial fundoplication (Toupet / Dor)
A partial 270° (Toupet) or anterior (Dor) wrap, preferred in patients with esophageal motility disorders to reduce the risk of post-operative dysphagia.
Combined & robotic approach
When a hiatal hernia coexists, it is repaired at the same time. In complex or recurrent cases the robotic platform offers enhanced precision.
Frequently asked questions
Can reflux be cured permanently?
Many patients are very well controlled with lifestyle and medication. When symptoms persist or there is dependence on drugs, surgical fundoplication can offer a durable solution.
When is surgery needed?
For inadequate response to medication, unwanted long-term dependence on it, a large hiatal hernia or complications such as stricture. The decision follows functional testing.
Is long-term PPI use dangerous?
PPIs are generally safe and effective. Long-term use is discussed individually with your doctor, weighing benefits against possible side effects.
What is Barrett's esophagus?
It is metaplasia of the esophageal lining due to chronic reflux. It is considered a precancerous condition and requires scheduled endoscopic surveillance.