Current pharmacological and procedural treatments for gastro-oesophageal reflux disease: comprehensive review

摘要

BACKGROUND: Gastro-oesophageal reflux disease (GORD) has a global prevalence of 14% and significantly impairs quality of life. Treatment for GORD is rapidly evolving due to advances in pharmacotherapy, surgical techniques, and new interventional approaches and devices. There are also ongoing refinements in patient selection for interventional therapy. This article reviews the latest developments. METHODS: An expert narrative review was conducted of the most recent literature. RESULTS: As a non-operative treatment, potassium-competitive acid blockers have emerged as an alternative to proton pump inhibitors (PPIs), receiving legislative approval in several countries, owing to their longer duration of acid suppression and higher rates of healing GORD complications. Surgically, research has continued to refine patient selection, perioperative decision-making, and intraoperative facets of laparoscopic fundoplication and hiatus hernia repair. Robotic antireflux surgery is also increasingly being performed internationally, with comparable clinical outcomes to laparoscopic approaches. Moreover, novel endoscopic techniques (antireflux mucosal ablation, antireflux mucosectomy surgery, transoral incisionless fundoplication, and the Medigus Ultrasonic Surgical Endostapler procedure) and devices (RefluxStop™ and LINX™) are being evaluated to treat GORD with varying levels of success. This review discusses the technical rationale, latest trial outcomes, potential pitfalls, and future considerations for these novel therapies. CONCLUSION: GORD is a highly prevalent disorder incurring significant morbidity. Although PPIs and laparoscopic fundoplication remain the current standards for the pharmacological and surgical treatment of GORD, novel drugs, approaches, techniques, and devices have emerged to tackle this important health issue. Their future utility will need to be proven against the current standards of care, and their success will enable personalized treatment for patients with GORD.