THE EFFECT OF MEDICAL THERAPY VERSUS ANTIREFLUX SURGERY ON DYSPHAGIA IN MANAGEMENT OF PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE WITHOUT EOSOPHAGEAL STRICTURE

Abstract

Gastroesophageal reflux disease (GERD) is a common disorder which affects both sexes equally. Its prevalence is relatively over the age of 30 and increases with age and also with the presence of hiatus hernia. There is now general agreement that competence is due to the combined action of the lower esophageal sphincter and mechanical factors which interact and function in consort. These mechanical factors include, the cardiac angle, the oblique fibers of the stomach, the mucosal folds at the lower end which from a rosette plugging and the intraabdominallength of the LES. (Cuschieri et al., 1990).

. Hormones that are known to increase the tone of the LES are, motilin and gastrin, whereas cholecystokinin, secretin, and vasoactive intestinal peptide cause decrease in LES tone (Yamashita et al., 1992).

Any alteration of these factors causes reflux of the stomach and duodenal contents into the esophagus causing reflux esophagitis and symptoms ofGERD.

Gastroesphageal reflux disease can be treated medically and surgically.

- The main indication of surgery are:

• Failure of medical treatment after 6 months especially m

patients with severe esophagitis (grade III and IV)

• In patients who have a definite evidence of a weak LES.