Normally, the continence of the lower oesophageal sphincter prevents the contents of the stomach from flowing back into the oesophagus. When acid reflux resists to simple medical treatment (proton pump inhibitors), the fol-lowing additional tests are recommended:

• Oesophagogastroduodenoscopy, carried out by your gastroenterologist
• pH-meter when the diagnosis of reflux is not certain.

Surgical treatment is necessary when medical treatment has failed. This procedure (Nis-sen) is always feasible under laparoscopy and consists in strengthening the lower oesophageal sphincter by creating an anti-reflux valve with the upper part of the stomach. The main complication is the difficulty in swallowing solid foods in the weeks following the operation (about 40% of cases), and the need to eat mixed and blended food during that time.