An Overview of Therapeutic Options between Proton Pump Inhibitors (PPI) and Fundoplication in Gastroesophageal Reflux Disease (GERD) Management | Chapter 4 | An Overview of Disease and Health Research Vol. 3

Introduction: Gastroesophageal reflux disease (GERD) is a prevalent, chronic condition characterised by the retrograde flow of gastric contents into the oesophagus, resulting in symptoms such as heartburn, regurgitation, and chest discomfort. The disease imposes a substantial burden on healthcare systems and significantly affects patients’ quality of life. First-line therapy for GERD typically includes lifestyle modifications and acid suppression with proton pump inhibitors (PPIs). While PPIs are effective in the majority of patients, a significant proportion report persistent symptoms or develop concerns about long-term use, including risks of nutrient malabsorption, renal complications, and infections. Surgical options, particularly laparoscopic Nissen fundoplication, provide symptomatic relief but carry the potential for adverse outcomes such as dysphagia, gas bloat, and surgical failure over time.

 

Aim: This review aimed to clarify the role of Stretta, transoral incisionless fundoplication (TIF), endoscopic full-thickness plication (EFTP), LINX® magnetic sphincter augmentation system, laparoscopic electrical stimulation (EndoStim®), and the RefluxStop™ implant in modern GERD management and define their potential in bridging the gap between conservative and surgical therapies.

 

Methods: This review evaluated current data on the emerging therapies, as well as techniques such as endoscopic mucosal resection and ablation seek to augment the anti-reflux barrier through mucosal remodelling.

 

Results: Evidence from multiple clinical studies and meta-analyses supports Stretta’s role in improving GERD-related quality of life, reducing oesophageal acid exposure, and, in many cases, lowering dependence on proton pump inhibitors. Moreover, both TIF and EFTP offer significant benefits as less invasive alternatives to traditional GERD surgery, with the potential for improved patient outcomes and quicker recovery times. While TIF is less invasive and focuses on reshaping the gastroesophageal junction to restore LES function, EFTP offers a more robust structural intervention, which may be preferable in patients with more severe GERD. As these therapies continue to evolve, understanding their efficacy, safety, and appropriate indications is critical. Minimally invasive and endoscopic therapies represent a significant advancement in the treatment of GERD, offering alternatives to conventional pharmacologic and surgical strategies. While data supporting these interventions are promising, particularly in terms of symptom relief and reduced acid exposure, most studies to date are limited by short follow-up periods, heterogeneity in study design, and variability in patient selection. Stretta, TIF, and EFTP show utility in enhancing lower oesophagal sphincter function with a favourable safety profile, particularly in patients with mild to moderate disease. Similarly, device-based interventions such as LINX® and EndoStim® offer innovative mechanisms of action with growing clinical support. More recently, anatomical solutions like the RefluxStop™ implant and endoscopic mucosal remodelling have opened new avenues for intervention, though they remain in earlier stages of evaluation.

 

Conclusion: In conclusion, while emerging GERD therapies do not yet replace conventional treatment, they significantly expand the therapeutic toolkit. Collaboration between gastroenterologists, surgeons, and patients is essential to select the most appropriate treatment strategy, balancing innovation with evidence-based care. With ongoing refinement and validation, these approaches have the potential to address unmet needs and reshape the standard of care for GERD. Future directions should focus on long-term outcomes, head-to-head comparative trials, and defining patient subgroups most likely to benefit from each therapy. Importantly, successful GERD management increasingly depends on a multidisciplinary approach that incorporates patient-specific factors such as motility patterns, anatomical features, symptom phenotype, and treatment preferences.

 

Author(s) Details

Harald Rosen
Centre of Surgery, Sigmund Freud Private University, A-1020 Vienna, Austria.

 

Christian Günther Sebesta
Science Center Donaustadt, Langobardenstrasse 122, A-1220 Vienna, Austria.

 

Marie Christine Sebesta
Science Center Donaustadt, Langobardenstrasse 122, A-1220 Vienna, Austria.

 

Christian Sebesta
Science Center Donaustadt, Langobardenstrasse 122, A-1220 Vienna, Austria and Department of Internal Medicine, Clinic Donaustadt, SMZ-Ost, Langobardenstrasse 122, A-1220 Vienna, Austria.

 

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