Review of antireflux procedures for proton pump inhibitor nonresponsive gastroesophageal reflux disease

L. Hillman, Rena Yadlapati*, M. Whitsett, A. J. Thuluvath, M. A. Berendsen, J. E. Pandolfino

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations


Up to 40% of patients with gastroesophageal reflux disease (GERD) report persistent symptoms despite proton pump inhibitor (PPI) therapy. This review outlines the evidence for surgical and endoscopic therapies for the treatment of PPI nonresponsive GERD. A literature search for GERD therapies from 2005 to 2015 in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews identified 2928 unique citations. Of those, 45 unique articles specific to surgical and endoscopic therapies for PPI nonresponsive GERD were reviewed. Laparoscopic fundoplication (n = 19) provides symptomatic and physiologic relief out to 10 years, though efficacy wanes with time. Magnetic sphincter augmentation (n = 6) and transoral incisionless fundoplication (n = 9) improve symptoms in PPI nonresponders and may offer fewer side effects than fundoplication, though long-term follow-up is lacking. Radiofrequency energy delivery (n = 8) has insufficient evidence for routine use in treating PPI nonresponsive GERD. Electrical stimulator implantation (n = 1) and endoscopic mucosal surgery (n = 2) are newer therapies under evaluation for the treatment of GERD. Laparoscopic fundoplication remains the most proven therapeutic approach. Newer antireflux procedures such as magnetic sphincter augmentation and transoral incisionless fundoplication offer alternatives with varying degrees of success, durability, and side effect profiles that may better suit individual patients. Larger head-to-head comparison trials are needed to better characterize the difference in symptom response and side effect profiles.

Original languageEnglish (US)
Pages (from-to)1-14
Number of pages14
JournalDiseases of the Esophagus
Issue number9
StatePublished - Sep 1 2017


  • Fundoplication
  • Lower esophageal sphincter
  • Refractory gastroesophageal reflux disease

ASJC Scopus subject areas

  • Gastroenterology


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