الفهرس 
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Abstract
Gastroesophageal reflux disease (GERD) is the most common esophageal disorder, affecting more than 20% of the population worldwide. GERD symptoms vary from simple heartburn and epigastric pain to more complex clinical situations, with a combination of other various extra-esophageal symptoms that include hoarseness, chronic cough, pharyngitis and laryngitis, and asthma.
In addition to its impact on quality of life, chronic GERD is a risk factor for numerous adverse events, such as esophageal stricture formation, Barrett’s metaplasia and esophageal adenocarcinoma, thus necessitating adequate diagnosis and treatment of this common entity.
The goals of clinical management of gastroesophageal disease (GERD) are prompt symptom relief, long-term symptom control, and maintenance of esophageal healing.
The standard treatments for gastroesophageal reflux disease (GERD) consist of the prescription of H2-receptor antagonists or proton-pump inhibitors (PPI). Daily use of proton pump inhibitors (PPI) is generally effective in the treatment of the majority of patients with gastroesophageal reflux disease (GERD); however, up to 40% have persisting symptoms.
The primary alternative to chronic PPI medication is laparoscopic antireflux surgery (LARS). Although surgery generally results in excellent control of reflux symptoms in the long term, both surgeons and patients are frequently reluctant to proceed to select this option. Indeed, LARS is associated with short- and long-term dysphagia, gas-bloat syndrome, and bowel dysfunction in a significant proportion of patients.
Recently, another class of minimally invasive treatments using flexible endoscopes has been introduced, broadening surgical options. full-thickness plication placed at the gastroesophageal junction reduced symptoms, medication use, and esophageal acid exposure associated with GERD.
The study is aimed to evaluate clinical efficacy of endosural suturing using gastroscope for patients with resistant GERD.
This is A Prospective study, was carried out on 25 adult patients having resistant GERD or Hiatus hernia at Gastroenterology outpatient’s clinic, endoscopic center, from September 2020 to March 2020.
The main results of the study revealed that:
The mean age was 43.8 (±7.2 SD), 15 were male, 10 were female, 14 were rural, 11 were urban.
The mean BMI was 26.8 (±3.1 SD), 5 were low weight, 5 were normal, 9 were over, 6 were obese.
5 were HTN, 5 were thyroid diseases, 6 were DM, 6 were with Diseases of the musculoskeletal system and connective tissue, 3 with Dyslipidemia.
5 were Heart burn, 5 were Regurgitation, 4 were asthma, 6 were with chronic cough, 3 with Laryngitis, 2 with Hoarseness.
the mean Ht was 30.20 (±2.38 SD), the mean Hb was 10.79(±0.94 SD), the mean RBCs was 3.88(±0.57 SD), the mean PLT was 255.85 (±48.42 SD)
The mean serum total bilirubin was 0.89(±0.23 SD), the mean Direct bilirubin was 0.2(±0.12 SD),the mean indirect bilirubin was 0.7(±0.1 SD), the mean ALT was 30.00 (±7.43 SD), the mean AST was 39.86 (±9.02 SD), the mean prothrombin time was 11.84 (±0.58 SD), the serum albumin was 4.4 (±1.19 SD).
The mean serum Creat. was 0.79(±0.24 SD), the mean Urea was 30.12(±5.87 SD), the mean Na was 142.07 (±4.00 SD), the mean K was 4.23 (±0.4 SD).
There were 10 with Anti HCV Ab, 9 with HbsAg.
According to US, there were 15 with A ‘trickling’ form of reflux in found GERD, and 5 cases with Only fast reflux episodes in no GERD finding.
According to Endoscopy, there were 20 with Esophagitis in found GERD, and 1 case with Incompetent cardia in no GERD finding.
The mean Reflux episodes in total at baseline was 185.75(±96.29 SD), the mean Reflux episodes in to talat 3 M was 66.81(±47.08 SD).
There was high significant difference between baseline Reflux episodes and after 3 M.
The mean Typical reflux at baseline was 19.79(±6.34 SD), the mean Typical reflux at 3 M was 9.3(±6.23 SD).
The mean atypical reflux at baseline was 10.14(±6.23 SD), the mean atypical reflux at 3 Mwas 5.37(±4.66 SD).
The mean Bowel dysfunction at baseline was 9.01(±4.6 SD), the mean Bowel dysfunction at 3 M was 5.88(±2.39 SD).
The mean Gas/bloating at baseline was 9.16(±7.04 SD), the mean Gas/bloating at 3 M was 5.59(±3.53 SD).
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.
Conclusion
Endoscopic full-thickness plication using the GERDx™ device improves the distal acid exposure of the esophagus, typical reflux-related symptoms and QoL in well-selected patients. This procedure might constitute an option for patients with mild GERD. Long-term outcomes are required to expand our knowledge on the effects of this procedure.