The gastroesophageal reflux disease (GERD) is a chronic, due to the retrograde flow of part of gastroduodenal contents into the esophagus and / or organs adjacent to it, causing variable spectrum of symptoms and / or signs of esophageal and / or extra-esophageal, or not associated with tissue damage.

GERD is considered today the most prevalent digestive tract, although it is difficult to obtain accurate estimate, since the vast majority of individuals who suffer from reflux symptoms resulting from not seeking medical care.

GERD has a negative impact on quality of life, increases health costs and the risk for malignant lesions pre.

The main clinical manifestations of GERD are heartburn typical (heartburn) and acid regurgitation, which means the return of food or acid content toward the oral cavity. The occurrence of atypical manifestations (retrosternal chest pain, feeling of "cake" in the throat, chronic cough, asthma, hoarseness, throat clearing, halitosis, thrush) sometimes is a real challenge to clinicians due to the difficulty of establishing an accurate diagnosis.

Currently, the biggest challenge for clinicians is to find the best strategy for the treatment of GERD, not only because of its broad spectrum of severity, but also by its chronicity, and should always evaluate each particular patient, since not infrequently, treatment involves the use of medication for life.

Clinical treatment aims to relieve symptoms, heal injuries, prevent relapses and prevent complications.

With practical purposes, one can divide the therapeutic approach in pharmacological and behavioral measures that must be implemented simultaneously in all stages of disease. In order to minimize reflux episodes, it imposes the changing habits of the patient's life, such as elevating the head of the bed, does not lie in the two hours after meals, avoid foods that promote reflux and irritate the mucosa esophagus (fried, greasy, garlic, onions, sweets, chocolates, soft drinks, alcoholic beverages, coffee and black tea), and not use drugs that attack the lining.

With respect to pharmacological treatment, a great variety of drugs have been used to treat the symptoms of GERD and for the healing of esophagitis. However, 10% to 20% of patients presumably remain partially or completely unresponsive to antacid therapy.

Surgical treatment in uncomplicated GERD should be considered in the following circumstances:

Patients who, for some reason (personal, economic, intolerance, etc..) Find themselves unable to continue the clinical treatment, including patients with atypical manifestations, whose reflux was proven devidademente;

Cases where continuous treatment is required for maintenance PPI (proton pump inhibitor) in the proper dose, especially in patients younger than 40 years who opt for surgical treatment.

In the complicated GERD Surgical treatment is indicated in stenoses and / or ulcer, and when there adenocarcinoma. Surgical treatment for fundoplication has been advocated by some authors as therapy for Barrett's esophagus. Is worth noting, however, that longitudinal studies comparing the clinical outcome of patients treated (IBP high dose) and surgery (fundoplication) demonstrate that all types of treatment was able to reduce the extent of metaplastic mucosa. On the other hand, were described several cases of adenocarcinoma in Barrett's esophagus occurred, years after the surgery.

Several new endoscopic treatments for GERD are undergoing clinical trials and some have been introduced in the medical community, but still a bit timid.

Finally, the definition of a therapeutic regimen in a patient with GERD has to be analyzed case by case, in proposing the end of treatment, one should take into account, in addition to the physician's experience, the type of patient studied, their conditions socioeconomic and possibilities of higher or lower adherence.