Grande et al. World Journal of Surgical Oncology 2012, 10:84 WORLD JOURNAL OF SURGICAL ONCOLOGY

Gastroesophageal reflux disease (GERD) represents an important medical problem in Western countries: about 20 % of the population in Western countries complain of experiencing typical symptoms of this disease (heartburn and acid regurgitation). Furthermore, the incidence is probably underestimated, because many patients have extraesophageal symptoms such as asthma, cough, hoarseness and chest pain [1,2]. GERD is associated with a variety of lesions, including esophageal erosion, ulceration, stricture and Barrett’s esophagus. Reflux-related symptoms and lesions do not necessarily coexist, however, given that about 30 % to 70 % of patients who complain of typical symptoms have no signs of esophagitis based on endoscopy [1]. There-fore, nonerosive reflux disease (NERD) and erosive esophagitis (EE) represent the most common clinical features of GERD. The increasing use of 24-hour pH-metry allowed us to select patients with or without a