Diagnosis and treatment of gastroesophageal reflux disease

Abstract

Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis, peptic stricture, Barrett’s esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification, medical therapy and surgical therapy. Lifestyle modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease.

Keywords: Gastroesophageal reflux disease; Esophageal disease; Acid suppression; Fundoplication; Upper gastrointestinal tract disorder

Core tip: Given the high prevalence of gastroesophageal reflux disease (GERD) and the various complications which can result from inadequate treatment, it is important for practioners to have a proper understanding of the current approach to its diagnosis and management. Diagnostic tools including various methods of pH testing are discussed. Furthermore, it is important to understand the indications and contraindications to anti-reflux surgery in order to optimize our patient’s surgical outcomes. Management of GERD in the obese patient may involve bariatric surgery and this is also further discussed.