Endoskopische und operative Therapie der gastroösophagealen Refluxkrankheit

Gastroesophageal reflux disease (GERD) remains a clinical challenge, especially in patients who do not respond to conservative therapy with proton pump inhibitors (PPIs). For decades, surgical treatment options such as laparoscopic fundoplication have been the primary strategies for PPI refractory patients. However, these procedures also have limitations in terms of long-term effectiveness and the occurrence of postoperative complications, highlighting the need for alternative therapeutic options. Recent advances in both endoscopic and surgical techniques offer promising solutions to address these unmet needs, with the potential to improve symptom control, reduce medication dependence, and minimize adverse effects. New approaches focus on restoring the normal function of the gastroesophageal junction, increasing the competence of the lower esophageal sphincter, and maintaining the physiological mechanisms of reflux control, while reducing the risk of posttherapeutic complications such as dysphagia and bloating. Current data show promising results in terms of symptom relief, improvement in quality of life, and reduction of acid exposure over an extended period. However, challenges remain, particularly in determining which individual therapy option to offer. Despite the availability of novel treatments, PPI therapy and traditional surgical antireflux techniques continue to serve as the gold standard. Nevertheless, the growing recognition of the limitations associated with these conventional approaches is driving the development of new therapeutic strategies. These innovations have the potential to transform GERD management by offering less invasive alternatives with fewer side effects, while ideally improving treatment efficiency and patient satisfaction. This evolving landscape suggests a possible shift in the GERD treatment paradigm, focusing on personalized approaches that balance efficacy, patient quality of life, and minimized posttherapeutic complications.