Gastroesophageal reflux disease (GERD) is a common digestive disease, which is characterized by recurrent symptoms like heartburn and acid regurgitation. The Institute of Digestive Disease of CUHK introduced a feasible and efficacious GERD treatment among Chinese patients.
GERD can cause damage of esophagus such as esophagitis and, in severe cases, narrowing or abnormal cell changes of esophagus. In Western populations, the risk of esophagus cancer in severe GERD patients is 44 times the risk in general population.
The Institute of Digestive Disease of The Chinese University of Hong Kong (CUHK) has recently completed a study on the epidemiological trend of GERD and other common upper digestive diseases in Hong Kong. In this study, we prospectively studied GERD patients who required long-term treatment in Prince of Wales Hospital (PWH) from 1996 to 2002 and the trend of yearly incidence and clinical presentation of GERD were monitored. The incidence trend of peptic ulcer and gastric cancer was evaluated by reviewing 32,807 upper endoscopy records in Endoscopy Center of PWH of the same period. During this period, the age-adjusted yearly incidence of Helicobacter pylori (H. pylori) related peptic ulcer has dropped substantially from 18 to 7.1 (61% reduction) per 10,000 HK residents. There was also a tendency of dropping incidence in stomach cancer. On the other hand, the yearly incidence of GERD and esophagitis has risen from 2.3 to 5.8 (152% increase) and 0.8 to 1.9 (138% increase) per 10,000 HK residents, respectively. Another alarming observation is that there is a trend of increasing proportion of complication (esophagitis) among young GERD patients. The current epidemiological trend in Hong Kong resembles that of Western population 20 years ago and we anticipate a rising trend of GERD related cancer in next two decades.
Our research has revealed two probable causes for the rising trend of GERD. First, there is a strong negative association between H. pylori and GERD. H. pylori may protect against development of GERD through its suppressive effect on stomach function, notably acid secretion. With the decline of H. pylori infection in Hong Kong, more people are vulnerable to development of GERD. Second, we have found that overweight and obesity cause loosening of the valve between esophagus and stomach and predispose to acid reflux. This functional disturbance is present even in overweight people without GERD. The abnormal valve function may be reversible in the early stage but it may not be remediable with weight reduction once GERD has occurred.
The Institute pioneered the introduction of laparoscopic fundoplication as a definitive surgical treatment for GERD among Chinese patients. The fundoplication is performed by mobilizing the fundus of the stomach, and wrapping the free fundus around the lower esophagus. The loosened lower esophageal sphincter can be strengthened by this fundoplication, and thus resulting in complete control of the GERD. Since 2001, thirty patients with typical symptoms of GERD were treated with laparoscopic fundoplication. They were confirmed to have significant acid reflux on 24 hour pH study. The average time to perform the laparoscopic fundoplication is 143 minutes. The patients were discharged from hospital 3 days after the operation, and there was no postoperative complication. All the patients are able to tolerate diet on the first day after surgery. The control of GERD is successful in 25 patients (83.3%) 2 years after surgery. These results confirmed the feasibility and efficacy of laparoscopic fundoplication in treating GERD among Chinese patients.