Both of these procedures, however, are associated with complications inherent in surgical intervention and can have chronic side effects such as bloating and dysphagia. This can include individuals who are intolerant to PPIs, those who are concerned about long-term medication use, or those who have advanced anatomical abnormalities of the gastroesophageal junction (such as a large hiatal hernia) preventing appropriate valve functioning. Surgical interventions, including Nissen fundoplication and the more commonly performed laparoscopic Nissen fundoplication, are available for those individuals who require anatomic correction. Additionally, although the absolute risk is low, multiple studies have shown an association between long-term PPI use and potential adverse health outcomes. However, researchers estimate that about a quarter of individuals experience a partial or suboptimal response to PPIs for a variety of reasons, including noncompliance and failure of the drugs to address an underlying incompetent gastroesophageal valve function, which is an anatomical abnormality not corrected by this class of medications. Until recently, proton pump inhibitors (PPIs) were deemed the treatment of choice for the majority of individuals with early disease and mild to moderate chronic symptoms, with plenty of study results demonstrating their efficacy. Some individuals experience a partial or suboptimal response to proton pump inhibitors due to incompetent gastroesophageal valve function. Incompetent gastroesophageal valve function
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