Surgical treatment of Gastroesophageal Reflux disease: yesterday and today

Abstract

Gastroesophageal reflux disease (GERD) is a set of signs and symptoms and changes resulting from pathological backward flow of gastric or intestinal contents to the esophagus. Reflux of gastric contents occurs periodically in all people during a 24-hour period. Therefore physiological reflux of gastric contents that does not cause any complaints or histopathological changes in the esophagus should be differentiated from gastroesophageal reflux disease that results in subjective complaints or its complications confirmed by diagnostic methods. Prevalence of gastroesophageal reflux disease is difficult to estimate, however it is believed to occur in 0.35 to 2% of the whole population (1). Before a decision is taken to proceed with surgical treatment, detailed diagnostic workup of causes of pathological gastroesophageal reflux is required and the strategy of surgical treatment should be based on three basic principles: alleviation of typical subjective complaints, healing and prevention of recurrences of reflux injury of the esophageal mucosa and prevention of possible complications of the long standing disease such as bleeding, ulceration and esophageal stricture, aspiration pneumonia and intestinal metaplasia. Approach of surgeons to pathogenesis of esophageal ulcerations changed since Quincke reported for the first time three cases of this condition in 1879. Quincke concluded that similar macroscopic nature of esophageal ulcers and gastric ulcers and close anatomical proximity indicated that reflux of gastric juice into the esophagus could be the cause of “ulcer ex digestion”. In 1906 Tileston presented a similar concept, on the basis of examination of 41 cases of esophageal ulcerations, supporting his concept with Albert’s publications from 1839. In 1946 Allison presented a new disease entity – “peptic oesophagitis”. He reported it on the basis of clinical signs and symptoms and radiographic picture. He concluded that abnormal reflux of gastric juice through abnormal cardia is a pathological factor of the new disease. However Barret in 1950 suggested a new term for the disease reported by Allison – reflux esophagitis that was to reflect relationship between esophagitis and the disease etiological factor. A paper published in 1988 allowed us to understand a role of individual anatomical factors of so called anti-reflux mechanism, protecting against pathological gastroesophageal reflux. Further progress in the understanding of gastroesophageal reflux was associated with development of diagnostic methods used to diagnose gastroesophageal reflux and its consequences. In 1926 Robin and Jankelson were the first to demonstrate gastroesophageal reflux using a radiological study (2-8). Detailed assessment of gastroesophageal reflux and development of knowledge about pathogenesis of reflux esophagitis facilitated progress in implementation of new methods of surgical treatment of this disease. In 1919 Soeresi was the first to perform an operation