13. What are the indications for an antireflux surgical procedure?

An antireflux operation is indicated for the treatment of objectively documented, relatively severe GERD.  Candidates for operation include patients with erosive esophagitis, stricture and Barrett esophagus, and those without severe mucosal injury who are dependent on proton pump inhibitors for symptom relief.

Patients with atypical or respiratory symptoms who have a good response to intensive medical therapy are also candidates.

An antireflux operation may be the preferred option in younger patients.

Also, those who are noncompliant with their drug regimen, those for whom medications are a financial burden and those who favor a single intervention over long-term drug treatment.

It may be the treatment of choice in patients who are at high risk for progression despite medical therapy.  Risks that predict progressive disease and poor response to medical therapy include

  1. nocturnal reflux on a 24 hour esophageal pH monitor,
  2. a structurally deficit lower esophageal sphincter,
  3. mixed reflux of gastric and duodenal juice, and
  4. mucosal injury at presentation.