Contemporary treatment of hiatal hernia and gastroesophageal reflux disease

Abstract

Introduction: The Gastroesophageal Reflux Disease (GERD) is the primary concern for the XXI century gastroenterology due to the hereinafter mentioned facts: • GERD ranks among the most common gastrointestinal diseases among mature population; 10% of global population suffers from GERD, fact which caused the appearance of the term ‘Gastroesophageal Reflux’ in the 10th edition of the International Classification of Diseases. • GERD requires a long-lasting antacid medication (min 3-6 months) and frequently repeated treatment courses inducing a high treatment cost. • Patients suffering from GERD are exposed to the high risk of morphohistological inflammatory, metaplasia and cancer complications (Reflux Esophagitis, Esofag Barrette, Esophagial Adenocarcinoma). Goal: Optimisation of contemporary individualized treatment of HH and GERD. Objectives: • Research of drug treatment schemes to elucidate the most efficient treatment schemes in curing the GERD depending on its evolution • Research and description of indications, methodology and short-term results of laparoscopic surgeries performed under GERD treatment by comparing the efficiency and gaps created by the implemented technologies. • Research of endoscopic methodology of GERD surgery to elucidate strengths and gaps among the short- and long-term results. Materials and methods: The authors highlighted the principles of the GERD treatment basing on data received after the retrospective, descriptive and monocentric study performed at the Municipal Clinical Hospital Nr. 1, Chisinau, Republic of Moldova, during 2010 - 2012. The authors have studied medical records of a group of 30 patients hospitalized according to the schedule into the section ‘Aseptic Surgery’ being diagnosed with GERD and HH. Results: • Medical treatment: Is implemented step by step (step up/down) depending on the clinical and paraclinical evolution, is long-lasting (2-6 months) with disease’s relapse in 87-90% of cases at 12 months after the cessation of the treatment, PPI appear to be the most efficient causing 61% of clinical resolution cases compared to 41% in H2 blockers’ case. • The endoscopic treatment: is poorly studied with short term results (12 months) that shows the reduction of the ER in 62% cases and healing in 40%. The abandoning of the PPI post operative treatment in 87% of cases. Is a bridge between the drug treatment and the laparoscopic one of the GERD. • The surgery tactics could be applied in only 10% of the total number of GER patients who face at least several conditions: HH and GER symptoms, complications (ER, EB, AE, SDH), the conservative treatment failed or appeared to be impossible, too young age (being an asset in the choice of the therapeutical technique). Conclusions: The study of the GERD modern treatment methods, both drug and surgery, has concluded that a patient who suffers from GERD needs an individual approach taking into consideration the stage and the evolution of the disease to deal successfully with it.