Gastroesophageal reflux disease (GERD) is a common disease in the West, but in the last decade, the incidence of the disease has increased significantly in Eastern countries such as China, Japan and South Korea, and epidemiologic data suggests that the incidence of GERD is about 12% in China, with about one-third of the patients having significant esophageal damage, i.e., reflux esophagitis. The root cause of GERD is the weak function of the barrier located at the esophageal junction, which leads to the reflux of gastric acid into the esophagus and even into the oral cavity and respiratory tract, causing a series of typical or atypical symptoms, such as heartburn, reflux, chest pain, and pneumonia and asthma, and may even ultimately develop into esophageal cancer. The emergence of proton pump inhibitors PPI (that is, a variety of azole drugs) has brought a revolutionary breakthrough in the treatment of GERD, the most important function of PPI is to significantly inhibit the generation of gastric acid, thereby greatly reducing the corrosive effect of acid, and can significantly alleviate the discomfort such as heartburn and other sensations, which is conducive to the alleviation of esophagitis.The emergence of PPI immediately changed the treatment options for GERD, and brought a boon to many patients. patients. Despite the increasing use of azoles, many doctors have found that up to 30% of patients with PPIs do not significantly improve their reflux symptoms, meaning that heartburn and reflux symptoms are defined as refractory reflux esophagitis if they remain unrelieved after 8 weeks of regular PPI treatment. In addition, some side effects of long-term application of PPI, such as inhibition of gastric emptying caused by dyspepsia, atrophic gastritis, gastric fundus gland polyps and liver function damage, etc., have also received more and more attention. So is there nothing that can be done for patients who cannot control their reflux symptoms with PPIs, or whose symptoms recur as soon as they stop taking the medication, or who are unwilling to take long-term medication because of the toxic side effects of the medication? In fact, as early as the beginning of the last century, some surgeons have explored the use of surgery to treat GERD. After decades of technical improvement and experience, surgical treatment has become a treatment option for GERD, and with the introduction of laparoscopic technology, the trauma of surgery has been further reduced, which has made laparoscopic surgery become the gold standard treatment for GERD. This procedure is called laparoscopic fundoplication, which can also be commonly referred to as anti-reflux surgery. The biggest difference between anti-reflux surgery and PPI medication is that PPI is aimed at the standard of GERD – gastric acid, i.e., lowering the acidity; while anti-reflux surgery is aimed at the root of GERD – the weak anti-reflux barrier, i.e., through surgery to build up a “scarf” at the weak point of GERD, so that it can be used at the root of GERD. This means that a “scarf” is surgically constructed at the weak point of the gastroesophageal junction, thus blocking the pathway of reflux at its root. Another feature of the surgery is that it can also repair the “accomplice” of GERD, the hiatal hernia, thus killing two birds with one stone. In this way, the biggest advantage of the surgery is to restore the anatomical weakness of GERD and to treat the cause of GERD. Moreover, surgery can slightly reduce the volume of the stomach, which can speed up gastric emptying and improve the symptoms of indigestion. In addition, surgery can have a “once and for all” effect, allowing patients to get rid of the “medicine pot” that has been bothering them for a long time. Of course, the advantages of surgical treatment are based on the analysis of clinical results. Analysis of large data based on tens of thousands of surgical patients in foreign countries has shown that the overall results of long-term use of PPIs and anti-reflux surgery in treating GERD are basically comparable, and surgery is slightly better in improving the quality of life of patients. Therefore, after diagnosis of GERD, patients should first be advised by their gastroenterologist to receive standardized PPI treatment. At the same time, patients should also be aware that apart from azoles, there is another “tool” for GERD treatment – anti-reflux surgery – and for patients with hiatal hernia, weak esophageal sphincter, or those who have not had good results with PPIs, surgery is undoubtedly a better choice. The choice. After a thorough evaluation of the patient’s condition, surgery is the best way to regain your health and get rid of your reflux disease.