[PPI or laparoscopic surgery in the treatment of reflux esophagitis?]

Proton pump inhibitor (PPI) is very effective in the initial treatment of reflux esophagitis. However, the recurrence ratio is high during maintenance therapy. Ten to 20% patients did not remained healed or the symptom were relapsed in spite of one year maintenance treatment with half or routine dose of PPI. Therefore, prolonged maintenance therapy with PPI is needed for many patients with symptomatic reflux esophagitis. On the other hand, surgical treatment is to repair functional disorder in defensive mechanism at esophagogastric junction which is main pathophysiology of reflux esophagitis. Surgical treatment is radical treatment for reflux esophagitis in this point of view. Nissen fundoplication has become the most commonly used antireflux procedure. Following fundoplication, 90% of the patients become symptom free in the long run. Laparoscopic Nissen fundoplication is as effective as open Nissen fundoplication in the short-term results. The average operation time is 2.5 hours, most of patients were discharged within two days after operation and lead to faster recovery from surgery than open procedure. Satisfaction rates ranged from 87 to 100%. Laparoscopic fundoplication can be performed with less morbidity than open procedure. Therefore, laparoscopic Nissen fundoplication is considered to be radical antireflux procedure. Compared to medical treatment, the life time costs of treatment are less with initial surgical management for men age 48 or below and women age 55 or below. The answer for "PPI or laparoscopic surgery in the treatment of reflux esophagitis" is laparoscopic surgery definitely.