What are the indications for fundoplication as a surgical treatment for gastroesophageal reflux disease (GERD)?

Updated: May 23, 2019
  • Author: Marco G Patti, MD; Chief Editor: BS Anand, MD  more...
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Answer

Indications for fundoplication include the following:

  • Patients with symptoms that are not completely controlled by PPI therapy can be considered for surgery; surgery can also be considered in patients with well-controlled GERD who desire definitive, one-time treatment

  • The presence of Barrett esophagus is an indication for surgery (whether acid suppression improves the outcome or prevents the progression of Barrett esophagus remains unknown, but most authorities recommend complete acid suppression in patients with histologically proven Barrett esophagus)

  • The presence of extraesophageal manifestations of GERD may indicate the need for surgery; these include the following: (1) respiratory manifestations (eg, cough, wheezing, aspiration); (2) ear, nose, and throat manifestations (eg, hoarseness, sore throat, otitis media); and (3) dental manifestations (eg, enamel erosion)

  • Young patients

  • Poor patient compliance with regard to medications

  • Postmenopausal women with osteoporosis

  • Patients with cardiac conduction defects

  • Cost of medical therapy


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