Indicações cirúrgicas para DRGE

Link: http://www.uptodate.com/contents/surgical-management-of-gastroesophageal-reflux-in-adults?source=search_result&search=hernia+de+hiato&selectedTitle=9~52

INTRODUCTION

Surgical management is generally reserved for patients with complications of reflux such as recurrent or refractory esophagitis, stricture, Barrett's metaplasia, persistent "reflux symptoms" despite acid suppression, or asthma. Patients who are unable to tolerate medication, noncompliant with medication, or who are medication dependent and unwilling to take lifelong medications are also surgical candidates.

INDICATIONS FOR OPERATION

There are several indications for surgery in the patient with GERD:

Gastrointestinal indications

Failed optimal medical management
Noncompliance with medical therapy
High volume reflux
Severe esophagitis by endoscopy
Benign stricture
Barrett's columnar-lined epithelium (without severe dysplasia or carcinoma)

The most frequent indication for antireflux surgery has traditionally been severe GERD unresponsive to optimal medical therapy, which consists of both drug therapy and lifestyle modifications [1]. Some patients continue to have substantial symptoms of "reflux" despite elimination of the heartburn component of their GERD and may wish to consider operation on this basis alone. However, continued symptoms despite adequate acid suppression with proton pump inhibitors (PPIs) should serve as a warning that symptoms may not be due to excess esophageal acid exposure but to functional heartburn, a malignancy, or extra-esophageal disease.