Antireflux

Antireflux refers to measures and treatments intended to prevent reflux of stomach contents into the esophagus, most often in the context of GERD and hiatal hernia. It includes lifestyle changes, medications, endoscopic therapies, and surgical procedures that aim to strengthen the gastroesophageal barrier or reduce acid exposure.

Non-surgical management emphasizes symptom control and risk reduction. Weight loss for overweight patients, raising the head of the bed, avoiding late or large meals, and limiting trigger foods (fatty foods, chocolate, caffeine, alcohol) and nicotine can help. Smoking cessation is advised. Pharmacologic therapy centers on acid suppression with proton pump inhibitors (PPIs) such as omeprazole or esomeprazole, and, when appropriate, H2 blockers. Antacids and alginates provide rapid relief or form a protective raft. Prokinetic medications are used selectively due to limited efficacy and side effects.

Endoscopic therapies seek to enhance the barrier without open surgery, including transoral fundoplication and related techniques; device-based methods are variable in durability and evidence.

Surgical approaches include anti-reflux operations, most commonly laparoscopic fundoplication. A full Nissen wrap reinforces the junction, while partial wraps (Toupet, Dor) are alternatives based on esophageal motility. Magnetic sphincter augmentation (LINX) is used in selected cases.

Outcomes vary by disease severity and anatomy. Antireflux strategies aim to alleviate symptoms, promote healing of esophagitis when present, and reduce reflux-related complications, with follow-up to monitor effectiveness and adverse effects.