Gastro-oesophageal reflux: when is surgery needed?
It affects 15-20% of adults and can lead to surgery. In these cases San Donato Group offers cutting-edge techniques with resolution in 95-97% of cases. We talk about it with Prof. Davide Bona of Galeazzi-Sant'Ambrogio Hospital.
Gastroesophageal reflux disease (GERD) is one of the clinical conditions with the highest incidence in the adult population and one of the main causes of access to gastroenterological care, but it is often underestimated.
We talk about it with Prof. Davide Bona, head of the General Surgery of the IRCCS Ospedale Galeazzi-Sant'Ambrogio, which operates as a level II centre and multidisciplinary national reference centre for the diagnosis and treatment of gastroesophageal reflux disease, integrating the skills of surgeons and gastroenterologists for the advanced management of the disease.
Gastro-oesophageal reflux disease: what is it?
Gastro-oesophageal reflux disease now affects about 15-20% of the Italian population. However, as Prof. Bona, who is also an Associate Professor at the University of Milan, makes clear: "To speak of MRGE, symptoms must:
- occur at a frequency of at least twice a week;
- last up to 1 year.
It is this precise clinical threshold that guides the specialist in the definition of a structured and personalised therapeutic pathway.
"At the Galeazzi-Sant'Ambrogio Hospital - the doctor emphasises - the diagnostic activity is oriented towards an accurate diagnosis of the pathology, distinguishing sporadic burning from full-blown reflux disease".
The Anatomical Causes of Reflux
Gastroesophageal reflux can have anatomical causes, with a focus on hiatal hernia. The sealing mechanism between the oesophagus and stomach is regulated by a sphincter, which loses its effectiveness in the presence of anatomical alterations.
"In these cases," continues Prof. Bona, "the angle of His, a fundamental natural protection against the rising of the gastric content, is lacking.
Identifying the hiatal hernia as a trigger allows surgeons to intervene directly on the problem.
The complications of gastro-oesophageal reflux
If neglected, reflux can evolve into esophagitis, caused by chronic inflammation. In more advanced cases, the formation of fibrotic scarring can generate oesophageal narrowing, impairing normal swallowing.
"The most prominent complication is Barrett's oesophagus, a condition that increases the risk of adenocarcinoma. Long-term untreated exposure is a risk factor for the development of a tumour,' the professor specifies.
The first treatment: medication
The treatment process initially involves drug therapies. For sporadic symptoms, the use of over-the-counter drugs, antacids and alginates, provides an immediate protective barrier. In contrast, proton pump inhibitors (gastroprotectors) are used to reduce acid production and control symptoms in most patients.
Prof. Bona clarifies a fundamental concept, however: 'If the cause is anatomical, the drug manages the symptom, but does not resolve the pathology. At the Galeazzi-Sant'Ambrogio, the priority is timeliness of diagnosis: that is why we discourage stand-alone remedies in favour of assisted specialist courses'.
Examinations for diagnosis
The gastroscopy is the first step to assess hiatal hernia and possible injuries of the oesophagus and stomach. In selected cases, second-stage examinations such as pH-impedance testing and esophageal manometry are used, which are also useful to study the function of the oesophagus before considering the surgical option.
When is reflux surgery indicated
Anti-reflux surgery is a definitive solution for selected patients. Indication criteria include:
- ineffectiveness of drug therapy in controlling symptoms and lesions;
- young patients wishing to avoid chronic dependence on drugs;
- presence of complications such as severe oesophagitis, fibrosis or Barrett's oesophagus;
- established presence of anatomical causes, such as hiatal hernia;
- documented need for chronic drug use.
Available antireflux surgeries
The hospital employs several state-of-the-art techniques, chosen according to the patient's characteristics. The main options include:
- Nissen's fundoplication (360°);
- Toupet's fundoplication (270°);
- refluxStop, a solution specifically indicated in case of oesophageal motility alterations.
"Operations are performed with a laparoscopic or robotic approach, with a 1-2 day hospitalisation and a rapid recovery," specifies Prof. Bona.
The patient can resume eating within the first few weeks, with transient complaints generally resolving quickly.
Anti-reflux surgery records a efficacy rate of 95-97%, confirming it as a safe procedure within a complete and personalised diagnostic pathway.
The Galeazzi-Sant'Ambrogio Gastro-oesophageal Reflux Centre
The integrated diagnostic pathway offered by the IRCCS Galeazzi-Sant'Ambrogio Hospital involves multidisciplinary assessments. As a centre of excellence for diseases of the upper digestive tract, Prof. Davide Bona and his team define the most appropriate strategy for each patient, resorting to surgery only when strictly necessary.
