Introduction

Gastroesophageal reflux is defined as the passage of gastric contents into the esophagus, and is considered a normal physiologic process. This reflux becomes a disease when patients develop troublesome symptoms and/or complications, which can be debilitating and progress to malignancy.[1] The pathophysiologic mechanism is a weak or incompetent lower esophageal sphincter (LES) along with a defect of the crura, i.e., hiatal hernia. The troublesome symptoms of gastroesophageal reflux disease (GERD) have compelled millions of people worldwide to seek medical and surgical therapies for relief.

GERD is becoming increasingly more common; in fact, the prevalence of GERD in North America and Europe is the highest prevalence worldwide with reported ranges of 18-28% and 9-26%, respectively. While slightly lower in other parts of the world, the prevalence in East Asia and the Middle East is still estimated at 2-7% and 9-21%, respectively.[2] GERD and its associated complications are also responsible for an increasing number of hospitalizations worldwide.[3]

In this chapter, we will briefly present the current status and challenges of treating GERD. We will discuss patient satisfaction and safety regarding anti-secretory medications. We will then examine the surgical techniques used to restore the barrier to reflux, focusing on magnetic sphincter augmentation (MSA) of the lower esophageal sphincter with the LINX^® device. We will review the available clinical data on MSA, as well as discuss evolving and potential future applications of MSA.