Related Experiment Video
Updated: Jun 2, 2026
04:14
Technical Considerations and Approach to Redo Foregut Surgery
Published on: September 22, 2023
Reflux parameters as modified by EsophyX or laparoscopic fundoplication in refractory GERD
M Frazzoni1, R Conigliaro, R Manta
1Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Modena, Italy. m.frazzoni@ausl.mo.it
Alimentary Pharmacology & Therapeutics
|May 5, 2011
Summary
Transoral incisionless fundoplication (EsophyX) was less effective than laparoscopic fundoplication for refractory GERD. EsophyX did not significantly improve reflux parameters or symptoms, unlike surgery.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Reflux Disease Management
Background:
- Gastroesophageal reflux disease (GERD) affects millions, with refractory cases posing significant challenges.
- Proton pump inhibitors (PPIs) are standard treatment, but some patients remain symptomatic.
- Transoral incisionless fundoplication (EsophyX) offers a minimally invasive approach, yet its efficacy in refractory GERD requires further study.
Purpose of the Study:
- To compare the effectiveness of EsophyX versus laparoscopic fundoplication in refractory GERD.
- To evaluate changes in reflux parameters and symptom association post-intervention.
- To assess the durability of treatment effects in PPI-refractory GERD patients.
Main Methods:
- An open-label study comparing EsophyX and laparoscopic fundoplication in refractory GERD patients.
- Impedance-pH monitoring performed before and 3 months after intervention (on and off PPIs).
- Assessment of esophageal acid exposure, distal and proximal reflux events, and symptom-reflux association.
Main Results:
- Laparoscopic fundoplication significantly reduced distal and proximal refluxes, unlike EsophyX.
- Post-operative esophageal acid exposure normalized in 100% of surgical patients vs. 50% with EsophyX.
- Symptom-reflux association persisted in 60% of EsophyX patients, versus 0% after surgery.
Conclusions:
- EsophyX fundoplication is significantly less effective than laparoscopic fundoplication for refractory GERD.
- EsophyX shows limited improvement in objective reflux parameters and symptom resolution.
- Laparoscopic fundoplication remains a more effective option for improving reflux control and symptom remission in this patient group.
Related Concept Videos
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:25Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is the backward flow of stomach contents (acid, pepsin, or bile) into the esophagus, causing mucosal inflammation known as esophagitis. It results from failure of antireflux mechanisms, mainly the lower esophageal sphincter (LES), influenced by mechanical and physiological factors.Etiology and Risk FactorsGERD develops when LES function is weakened or when intra-abdominal pressure increases. Risk factors include aging, obesity, and sliding hiatal hernia,...
01:29Gastroesophageal Reflux Disease I: Meaning and Pathophysiology
Gastroesophageal Reflux Disease (GERD) involves the recurrent backflow of the stomach or duodenal contents into the esophagus, leading to troublesome symptoms and potential esophageal mucosal damage. Although GERD is often referred to as a disease, it is more accurately described as a syndrome, as it encompasses a range of symptoms and complications rather than a singular pathological entity, impacting a large number of individuals as the most prevalent upper gastrointestinal problem. Roughly...
01:21Barrett Esophagus-II: Clinical Manifestations and Management
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure entails...
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure entails...
01:26Esophageal Strictures-II: Clinical Features and Management
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:30Esophageal Strictures-I: Introduction
Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...