Diagnosis and treatment of gastroesophageal reflux and related diseases

Abstract

The diagnosis of gastroesophageal reflux disease (GERD) remains challenging due to symptom overlap with functional gastrointestinal disorders, where no organic cause is identified. Objective reflux testing plays a crucial role in identifying and characterizing patients with clinically significant GERD. Initial management involves lifestyle modifications and pharmacological therapy. However, for patients who are unresponsive to medications or wish to avoid long-term drug dependence, surgical intervention has proven to be a cost-effective alternative. Beyond typical GERD symptoms, a subset of patients experience laryngopharyngeal reflux (LPR), which manifests as atypical symptoms such as hoarseness, chronic cough, dental erosion, and asthma. These cases present additional diagnostic and therapeutic challenges due to unclear surgical indications. This thesis examines the evolution of GERD diagnostic criteria, supplemented by local data analyzing different acid exposure thresholds in predicting GERD-related complications. The second chapter evaluates outcomes of laparoscopic fundoplication, the gold standard antireflux procedure, with a focus on intraoperative EndoFLIP assessment data to delineate the components of the antireflux barrier. Additionally, a pilot study on laparoscopic magnetic sphincter augmentation (MSA) in an Asian population is presented, demonstrating non-inferiority compared to a historical fundoplication cohort. Given the association between GERD/LPR-related microaspiration and adverse outcomes in lung transplant patients, the thesis also explores the incidence of GERD via objective testing, revealing a trend toward poorer survival in patients with higher esophageal acid exposure. Future directions include the development of a well-tolerated, one-stop GERD assessment protocol. With expanding minimally invasive treatment options and broadening surgical indications, advancements in GERD management are anticipated. The establishment of the Asian Foregut Society aims to foster multidisciplinary collaboration, research, and education, ultimately driving innovation in the field.