The Annals of Thoracic Surgery, Vol 31, 577-593, Copyright © 1981 by The Society of Thoracic Surgeons
Gastroesophageal reflux: medical and surgical management
JD Cooper and KN Jeejeebhoy
The assessment of gastroesophageal reflux requires a carefully taken
history and appropriate selection of the relevant diagnostic tests from
among the many such tests available. Gastroesophageal reflux is generally
produced by an imbalance between the intragastric pressure on the one hand
and the degree of competence of the lower esophageal sphincter on the
other. Medical management incorporates measures designed to promote gastric
emptying, augment the resting tone of the lower esophageal sphincter, and
favorably alter the nature of the refluxed material by dietary and
pharmacological means. The surgical techniques commonly applied for the
prevention of gastroesophageal reflux aim to restore an intraabdominal
segment of esophagus and to augment sphincter competence by either a
partial or complete fundoplication. Comparison of results obtained with
various operations is difficult, as assessment is often imprecise,
subjective, and partisan. Development of a uniform method of postoperative
assessment, free from observed bias, would be a major advance.
