[Gastroesophageal reflux: alternatives to medical treatment]

The vast majority of patients having gastroesophageal reflux disease (GERD) are well-controlled by medical therapy. Surgical treatment is indicated for patients who do not want to take life-long medication, those having persisting symptoms despite PPI therapy or those having atypical symptoms associated with GERD. Although very effective, surgical treatment is loosing part of its efficacy after 10 years and may be associated with chronic or acute complications. This is probably one of the reasons why only a small minority of patients having GERD will ask for surgical therapy. Many endoscopic techniques for treating GERD have been the topic of great enthusiasm over the last 10 years. Most of them, however, have been abandoned either because of severe adverse events, lack of efficacy or non adoption by physicians for routine clinical use. Only few of them have survived and are still used or in development. They include radiofrequency application at the lower esophagus, which is probably indicated in subgroup of patients having symptomatic GERD in the absence of esophagitis and techniques of endoscopic suture which aims to recreate a gastroesophageal valve by endoscopic route. Up to now, most of the published studies dealing with endoscopic treatment of GERD have been focused on patients having typical GERD symptoms who are also those having the highest benefit from PPI therapy. Interestingly, the group which could really benefit from this kind of treatment, namely those patients having persisting symptoms under PPI therapy or those having atypical GERD symptoms have been the topic of much less investigations.