Gastroesophageal reflux disease

The Guidelines of the American College of Gastroenterology and the Montreal Consensus Group respectively define the gastro-esophageal reflux disease (GERD) as “ …a condition in which symptoms or mucosal damage are caused by the abnormal reflux of gastric contents into the esophagus …” and ‘‘a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications’’. Symptoms are considered ‘‘troublesome’’ if they adversely affect an individual’s well-being. The definition of GERD incorporates pathophysiologic concepts that allow its clinical application. The prevalence of GERD in the world has progressively increased over the last two decades; reflux disease today is more common in Asian countries than it was previously recognized. A systematic review of 15 epidemiologic studies, performed considering the definition of GERD as the presence at least weekly of heartburn and/or acid regurgitation, estimated an overall prevalence of 10 to 20 percent in the Western world. Several studies have reported on the prevalence of GERD in Europe with evidence of increase with time. Overall, there appears to be a lower prevalence of GERD in Europe compared to North America. There is some indication that the prevalence may be lower in southern than northern Europe. The choice of the surgical option must be very careful .The correct indication for surgical therapy, the choice of the surgical technique to tailor for each patient, the proper realization of the operation do need deep knowledge of the pathophysiology of the upper gastro-intestinal tract, familiarity with the diagnostic techniques, clinical experience. The therapy of every benign disease of the esophagus and in particular of GERD, is for the surgeon a great responsibility for two reasons: the aim of the therapy is wellness not survival; the patients, particularly the younger ones, will enjoy or suffer the action of the surgeon along their entire life. In this chapter we aim to offer the reader what is necessary to know in order to afford the task.