Gastroesophageal Reflux Disease (GERD)

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Gastroesophageal Reflux Disease (GERD) is a condition in which stomach contents and acid flow back into the esophagus. Most often, this occurs because the valve between the esophagus and the stomach does not close completely. As a result, acidic liquid from the stomach enters the esophagus, causing symptoms like heartburn and pain in the chest and throat area. In many cases, this leads to chronic discomfort and negatively impacts the patient’s quality of life.

Statistics in Georgia
The prevalence of GERD in Georgia is relatively high. It is estimated that 10-15% of the population regularly experiences heartburn or similar symptoms, and according to general data, the disease progresses to a complicated form in 1-2% of cases.

Treatment Methods
GERD can be managed both conservatively and surgically. The main treatment approaches include:

Lifestyle changes: Adjusting diet, controlling weight, and limiting harmful habits (such as alcohol and smoking).
Drug therapy: Proton pump inhibitors (PPIs) and antacids, which reduce stomach acid production and help alleviate heartburn.
Endoscopic procedures: These may be considered when medications are ineffective, offering an alternative to surgery for some patients.

Surgical Treatment
Surgical intervention is recommended in the following cases:

When drug therapy is ineffective or requires long-term use.
If there are severe esophageal conditions, such as Barrett’s esophagus or esophageal stenosis.
If the patient cannot tolerate proton pump inhibitors.

Fundoplication is a surgical procedure designed to alleviate GERD symptoms and prevent stomach contents from flowing back into the esophagus. The operation is performed laparoscopically and involves the following steps:

Creating a Cuff from the Fundus of the Stomach – The surgeon begins by carefully detaching the upper part of the stomach, called the fundus, from the surrounding tissues. This section of the stomach will later be used to create the cuff.
Wrapping the Fundus Around the Lower Esophagus – The fundus is then wrapped around the lower esophagus. This step involves twisting the upper part of the stomach to form a loop, allowing the cuff to function as a strong valve.
Cuffing – The fundus is secured in place, forming a cuff around the lower esophagus. This setup makes it difficult for stomach contents to reflux into the esophagus, while also allowing the esophagus to expand freely as food passes through.
Valve Function – The cuff acts as a tight valve, preventing stomach acid from backing up and providing additional support to the lower esophagus.

There are several types of fundoplication, with Nissen fundoplication being the most common. In this procedure, the fundus is tightly wrapped around the esophagus in a 360-degree fashion, strengthening the lower esophageal sphincter.

Results: Most patients experience significant relief after fundoplication, with a reduction in heartburn and other reflux symptoms.

Conclusion
GERD is a common condition that can be effectively managed with both medical treatment and surgery. Surgical intervention, particularly fundoplication, is mainly recommended in severe cases where other treatments have proven ineffective.