GASTROESOPHAGEAL REFLUX DISEASE: DIFFERENT TREATMENT APPROACHES

Paudel K. R.*

ABSTRACT

Gastroesophageal reflux disease (GERD) is chronic esophageal disorder which occurs due to reflux of gastric juice and or contents to the lower third of esophagus, and has a prevalence of 6.3 to 28% in general population. Usually, lower esophageal sphincter (LES) is dysfunctional or incompetent to prevent reflux of gastric contents to the esophagus. Serious complication of the GERD includes Barrett’s esophagus which may progress into esophageal adenocarcinoma. Use of proton pump inhibitors (PPIs) along with non-pharmacological measures is the treatment of choice in GERD. If the first choice of treatment fails, pharmacological agents other than PPIs such as H2 blockers, antacids, prokinetic agents and sodium alginate can be used. However, these agents are inferior to PPIs in terms of efficacy and side effect profile, and not indicated for long term management. A novel drug vonoprazan which is a potassium competitive blocker of H+/K+ ATPase enzyme has also been developed to manage GERD symptoms. If non-pharmacological and pharmacological approaches fail to treat the GERD, different surgical approaches such as laparoscopic fundoplication, robotic fundoplication, endoluminal suture or plication of gastroesophageal junction (GEJ), radiofrequency thermal therapy of the LES and injection or implantation of biopolymers in GEJ are useful to manage the GERD refractory to drug therapy.

Keywords: Endoscopy, Flundoplication, Gastroesophageal reflux disease, Proton pump inhibitors, Vonoprazan.