Managing Failed Anti-Reflux Therapy.

CAlthough GERD was initially described in the early 19th century, it is essentially a consequence of our modern day largesse. Dietary factors and associated obesity have combined with as yet other unknown factors (e.g. a decrease in the prevalence of H. pylori?) to make GERD one of the most common diseases affecting western society. It is estimated that up to 20 million adults in the United States suffer from GERD, and treatment of these individuals consumes approximately $10 billion annually, the majority of it for prescription drugs used to manage the disease and its symptoms. Fortunately, despite challenges presented by co-factors resulting in GERD (diet, obesity, etc.), therapy of GERD is largely successful. However, even a low failure rate for a therapy used in the management of GERD still results in large numbers of affected patients because of the high prevalence of this disease. Use of a conservative estimate of a failure rate of 5% translates to 1 million ineffectively treated and unhappy patients. How to manage these patients is the subject of this book.
Why is publication of this book important now? Several factors prompted us to work on this project.Mature results for proton pump inhibitor use are available, making this an appropriate time to review outcomes of PPI therapy of GERD. Similarly,mature results are now available for minimally invasive surgical therapy for GERD. In fact, results are
sufficiently promising in the mid-term that some authors are recommending surgery over PPI use even for patients with only moderate GERD disease. In addition to defining the success of these therapies, the long-term results also illustrate important failure rates and help define characteristics of patients who are less likely to benefit from  conventional treatment options.