title: [Reflux and hiatus hernia in the controversy between conservative and operative therapy].
abstract: Approximately 20 % of the population are affected by gastroesophageal reflux disease (GERD). The subjective clinical and objective pathological extent of the disease is highly variable and the underlying pathophysiological mechanisms extraordinarily diverse. The importance of hiatus hernia for GERD has been intensively debated for decades. Hiatus hernia was initially considered to be at the center of the pathophysiology but later the function of the lower esophageal sphincter was increasingly considered to be of importance. Currently, additional relevant pathophysiological cofactors are being detected with the continuous improvement in diagnostic methods and used for therapeutic decision-making. Despite standardization of the operative technique and increasing criticism on long-term proton pump inhibitor (PPI) therapy, antireflux surgery still requires a very critical assessment of indications based on a comprehensive diagnostic evaluation.
authors.affiliation: Chirurgische Klinik, Interdisziplinäres Bauchzentrum, Darmkrebszentrum Bremen West, DIAKO Ev. Diakonie-Krankenhaus gGmbH, Gröpelinger Heerstr. 406-408, 28239, Bremen, Deutschland, chirurgie@diako-bremen.de.
authors.forename: S M
authors.initials: SM
authors.lastname: Freys
authors.forename: J
authors.initials: J
authors.lastname: Heimbucher
mesh_terms: D000465:Algorithms; D003937:Diagnosis, Differential; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors