Article
Management of GERD
Management des GERD
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Authors
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Jürgen F Riemann
- Med C, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Anika Rosenbaum
- Med C, Klinikum, Ludwigshafen, Germany
| Published: | September 7, 2006 |
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Outline
Text
In Germany, 8 million people suffer from heartburn. Gastroesophageal reflux disease (GERD), the underlying condition, is usually benign, but quality of life is often impaired to a large extend.
The clinical diagnosis is based on the major symptom of heartburn. In contrast to international guidelines, the German DGVS (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten) recommends early endoscopy in order to differentiate the non-erosive (NERD) and the erosive form (ERD), and to exclude malignancy, even if alarming symptoms are absent. Several classifications of endoscopic findings in GERD exist. Two of the most commonly used are the one by Savary and Miller and the Los Angeles classification.
Therapy of GERD includes the whole spectrum from basic conservative measures and medication to endoscopy and surgery. Several patients with GERD need to be put on continuous life-long medication with proton-pump inhibitors. Therefore, many different endoscopic techniques were developed in order to relieve symptoms permanently. They are based on radiofrequency energy (Stretta®), injection of polymer (Enteryx®, Gatekeeper®), or endoscopic suturing (ESD®, Gastroplikator®, Endocinch®). Some of these products ((Enteryx®, Gatekeeper®, ESD®) have already been withdrawn from the market, due to technical problems, lack of efficacy and/or serious complications. Among the remaining techniques, Stretta shows the most promising long-term results with over 60% responders. Nevertheless, its clinical use is limited due to initial severe complications including perforations and procedure-related deaths. Despite of excellent short-term results, the follow-up of endoscopic suturing procedures is disappointing. Sutures are lost to a high extend, the prodedures are ineffective. Only the plicator seems to be of some effect.
Concerning complications of GERD, the Barrett’s Esophagus (BE) is subject to endoscopic surveillance and, in select cases, to endoscopic therapy (endoscopical resection or photodynamic therapy). Both, endoscopic surveillance and therapy of BE are considered to be standard procedures in the management of GERD.
