Surgery

Surgery is considered an option only when long-term maintenance antireflux therapy is expected, but is too expensive for the patient (eg, in infants and children), or in the rare case in which the patient builds up tolerance to PPIs.[Katz PO, 2001]

Surgery seems to provide better results in the long term compared with medical treatment, with the best results seen in patients with nocturnal asthma, laryngeal inflammation, and those who have responded to antireflux medication.[Klaus A, 2001]

Several antireflux surgical methods are proven to reduce the number of respiratory complaints associated with gastro-oesophageal reflux, with long-lasting benefits.[Greason KL, 2002]

One of the surgical methods used, laparoscopic Nissen fundoplication (LNF) involves wrapping the upper part of the stomach around the lower part of the oesophagus, thus reconstructing the LOS. This increases the resting pressure of the LOS, thereby decreasing the number of reflux episodes.

LNF is effective in reducing symptoms and improving quality of life in patients with atypical symptoms of GORD.[Duffy JP, 2003] In patients suffering from chronic cough only attributable to GORD, quality of life was again improved with LNF, and the severity of cough was reduced.[Novitsky YW, 2002]

Nissen fundoplication has been successfully used to treat patients with asthma who sublingually aspirate as a consequence of GORD.[Zaloga GP, 1983]

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