Why is laparoscopic fundoplication the preferred 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

Although a prospective, randomized trial has never been performed to compare PPIs to laparoscopic fundoplication, the authors believe fundoplication is preferable for the following reasons:

  • PPIs, although effective in controlling the acid component of the refluxate, do not eliminate the reflux of bile, which some believe to be a major contributor to the pathogenesis of Barrett epithelium

  • Patients with Barrett esophagus tend to have lower LES pressure and worse esophageal peristalsis than patients without Barrett esophagus; patients with Barrett esophagus are also exposed to a larger amount of reflux

  • A fundoplication offers the only possibility of stopping any kind of reflux by creating a competent LES; however, until the definitive answer is known, the authors recommend that patients with Barrett esophagus should continue to undergo periodic endoscopic surveillance even after laparoscopic fundoplication


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