The laparoscopic nissen fundoplication eliminates obstructive sleep apnea syndrome due to gastroesophageal reflux disease

Nocturnal Gastroesophageal Reflux Disease (GERD) and Sleep: An Important Relationship That Is Commonly Overlooked

Gastroesophageal reflux disease (GERD) is a prevalent, chronic medical condition that affects 13% of the adult population globally at least once a week. Sleep disturbances are frequently encountered in up to 25% of the GERD patients, likely due to nocturnal gastroesophageal reflux (GER). With advance in diagnostic techniques allowing for an improved understanding of involved physiological mechanisms of nocturnal reflux, there is growing evidence of a bidirectional relationship between GERD and sleep disturbances. Furthermore, nocturnal GER is associated with more complicated GERD. Obstructive sleep apnea (OSA) and GERD also have been linked, but to what degree remains controversial. Treatment of nocturnal GER has been shown to improve both subjective and objective sleep measures. The therapeutic approach includes lifestyle modifications and medication individualization and optimization with proton-pump inhibitors serving as the mainstay of treatment. Antireflux surgery and newer endoscopic procedures have been demonstrated to control nocturnal GER.

Surgical treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a very common foregut disease prevalent worldwide. The prevalence of GERD has risen strikingly over the past decades, causing substantial health and economic burdens. Due to high rates of recurrent reflux symptoms, reoperations and complications, surgical therapy of GERD did not attach enough attention in its early stage. However, surgical therapy for GERD was subsequently revolutionized by the development of anti-reflux surgical techniques and the introduction and popularization of minimally invasive surgeries. Anti-reflux surgery has gradually proved to be a well-documented, effective, therapeutic option for GERD by long-term follow-up studies. In order to improve results and to reduce unwanted effects, surgeons should master the indications of surgery and techniques of anti-reflux surgery. Besides, choosing appropriate candidates and surgical approach is also crucial for outcomes. However, limited by the regional economy and surgeon's skill, the use of anti-reflux surgery is still very limited. The aim of this review is to analyze and discuss the current spectrum of surgical therapy of GERD, and to provide orientation for surgeons in the challenging therapy of GERD.