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Rosen: Gastro-oesophageal reflux – an increasing burden

Although gastro-oesophageal reflux disease (GORD) is a disorder that has been well known for decades, it is indisputable that it has become an increasing problem as a consequence of factors that are strongly associated with modern lifestyle in the so-called ‘civilized world’.

Continuously rising rates of obesity are strongly associated with an increasing number of patients who are seeking help from their doctors because of a reduction in their quality of life due to the reflux of gastric content and mechanically caused symptoms of hiatal hernia.

In addition to the impact of GORD on daily life and socioeconomic factors (e.g. medical costs), there is increasing scientific evidence of a strong correlation between GORD and a distinctive change to the histological pattern seen in oesophageal carcinoma, which shows a marked shift from squamous cell cancer in the mid and upper oesophagos to adenocarcinoma in the distal oesophagus and gastro-oesophageal junction.

Therefore, physicians are increasingly confronted by the need to evaluate early those individuals who are at risk of developing cancer, while also dealing with the significantly larger number of patients who seek relief from symptoms that are reducing their quality of life.

In contrast to the standard therapeutic approaches of the past, there has been a recent shift towards a more individualized approach in the treatment of patients suffering from GORD. Long-standing conservative therapies with proton pump inhibitors and/or antacids have been discussed with growing dissatisfaction in recent literature.

For this reason, and as a result of technical innovations, alternative (but still minimally invasive) therapeutic approaches, which can be endoscopic and/or surgical, are increasingly available for the prevention of GORD.

We are extremely grateful that this significant topic has been addressed in two excellent reviews by the Head of Upper Gastrointestinal Surgery at the Medical University of Vienna, Professor Sebastian Schoppmann, which will give the readers of this issue of the Hamdan Medical Journal an authoritative overview of the modern management of this important disorder.

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