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Panminerva Medica 1998 June;40(2):139-45

lingua: Inglese

Therapeutic ­options in the man­age­ment of gas­troe­soph­a­geal ­reflux dis­ease

De Simone M., Cioffi U.*

From the Department of General and Thoracic Surgery * Department of General and Oncologic Surgery Ospedale Maggiore Policlinico ­IRCCS University of Milan, Milan, Italy


The treat­ment of gas­troe­soph­a­geal ­reflux dis­ease ­requires an indi­vid­u­al­ized ­approach, and aims to ­remove the symp­toms, to ­heal the esoph­a­gitis, and to pre­vent the recur­rence or com­pli­ca­tions. These objec­tives are ­obtained reduc­ing the inci­dence of the dam­ag­ing ­reflux ­into the esoph­a­gus by improv­ing the anti­re­flux bar­ri­er, decreas­ing the gas­tric ­acid com­po­nent, enhanc­ing the esoph­a­geal clear­ance. Depending on the sever­ity of the dis­ease, gas­troe­soph­a­geal ­reflux dis­ease may be man­aged ­through a com­bi­na­tion of life­style mod­ifi­ca­tions, ant­ac­id-anti­re­flux­ant ­drugs, prok­i­net­ic ­drugs, recep­tor-H2-antag­o­nists, pro­ton ­pump inhib­i­tors or sur­gery. Antireflux sur­gery ­should be con­sid­ered in sev­er­al sit­u­a­tions. All ­patients, espe­cial­ly at ­a young age, who ­have an insuf­fi­cient ­response to med­i­cal man­age­ment, pre­sent­ing ­with a mechan­i­cal­ly defec­tive low­er esoph­a­geal sphinc­ter or ­with var­i­ous ­grades of com­pli­ca­tions are can­di­dates for sur­gery. Although a sur­gery is rare­ly ­used as treat­ment ­option in ­patients affect­ed by gas­troe­soph­a­geal ­reflux dis­ease, the per­cent­age of suc­cess is ­upper to 80-90%, espe­cial­ly ­after the intro­duc­tion of min­i­mal­ly inva­sive pro­ce­dures, ­with sig­nif­i­cant­ly ad ­vitam ­reduced ­costs.

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