ABSTRACT
Over the past decade, there has been a significant shift in the role of surgery for the treatment of gastroesophageal reflux disease (GERD). Anti-reflux surgery, once reserved for severe disease refractory to medical therapy, is now considered appropriate for many patients without mucosal complications. Several factors have contributed to the growing acceptance of surgery for reflux disease. One such factor is the appreciation that abnormal reflux can result in serious esophageal complications, such as ulcerations, strictures, and the development of Barrett’s metaplasia. It is well recognized that many of the extraesophageal symptoms observed in patients with GERD, including laryngitis, erosion of dental enamel, and pulmonary disorders (asthma, chronic cough, bronchitis), are due to refluxed gastric material entering the oropharyngeal cavity and lungs. Although medical therapy with proton-pump inhibitors is fairly effective in controlling heartburn and esophagitis, it is less effective in controlling these extra-esophageal symptoms.
