The pathogenesis and surgical treatment progress of gastroesophageal reflux disease

Gastroesophageal reflux disease is a common gastrointestinal disorder worldwide, with a particularly high prevalence in Western countries, and its incidence has been rising steadily in Asia in recent years. The pathogenesis involves dysfunction of the lower esophageal sphincter, inadequate support of the crural diaphragm, disruption of the His angle and gastroesophageal flap valve, the formation of a postprandial acid pocket, and delayed gastric emptying in some patients. Surgical intervention is required for patients with severe symptoms or complications. Traditional fundoplication provides effective symptom control, but postoperative complications such as dysphagia and gas-bloat syndrome remain concerns; in cases of short esophagus or large hiatal hernia, Collis gastroplasty or mesh reinforcement may be necessary. In recent years, the advancement of minimally invasive techniques has facilitated the application of robot-assisted surgery, magnetic sphincter augmentation, transoral incisionless fundoplication, and lower esophageal sphincter electrical stimulation, which emphasize minimal invasiveness, functional preservation, and individualized approaches. Whether the concept of "asymptomatic elective repair", as applied in inguinal hernia, can be extended to certain hiatal hernia patients remains to be further explored.