OBJECTIVES

The prevalence and burden of gastroesophageal reflux disease (GERD) and the outcomes associated with magnetic sphincter augmentation (MSA) have previously been evaluated. However, evidence for describing the patient population that may benefit most from MSA have not yet been summarized. The purpose of this review was to identify and describe the optimal population for MSA.

METHODS

Comprehensive searches of the literature and guidelines were performed using the Medline (PubMed), EMBASE databases, and the National Guideline Clearinghouse (NGS) with the timeframe of January 1, 2000 to October 16, 2018. Inclusion criteria were publications presenting evidence for describing, identifying, and treating potential candidates for MSA. Exclusion criteria included publication of abstracts only, case reports, letters, or commentaries; animal studies; languages other than English; and duplicate studies.

RESULTS

A total of 86 articles were included. Persistent GERD symptoms despite PPI therapy are typically indicative of an incompetent lower esophageal sphincter (LES) that allows abnormal reflux of gastric contents into the esophagus. For these patients, anti-reflux surgery may be an optimal treatment option. While laparoscopic Nissen fundoplication (LNF) is the de facto surgical option, it has several limitations. As an alternative, MSA with the LINX Reflux Management System is considered efficacious, reversible and reproducible, and associated with fewer side effects than LNF. The optimal MSA population may be the 2.2-2.4% of GERD patients who, despite optimal medical management, continue experiencing primary symptoms of uncontrolled regurgitation, have abnormal pH, and have intact esophageal function as determined by high resolution manometry or barium esophagogram.

CONCLUSIONS

Opportunities may exist for improving the care of GERD with anti-reflux surgical options such as MSA. Establishing an evidence-based algorithmic approach can help ascertain surgical necessity but also ensure that patients have all treatment options available to them to optimally control their reflux disease, thereby increasing their quality of life, and minimizing potential side-effects.