Gastroesophageal reflux disease: current insights into pathogenesis, diagnosis and treatment.

Abstract

Gastroesophageal reflux disease (GERD) affects millions of people worldwide with significant clinical consequences [1, 2]. GERD presents with recurrent and severe heartburn and regurgitation or GERD-specific complications and affects approximately 20% of the adult population in high-income countries [3, 4, 5]. GERD has a worldwide prevalence of 8% to 33%, affects all age groups and both sexes [6, 7], and has a cost estimated at >$9-10 billion per year in the US alone, largely due to associated with using of proton pump inhibitors (PPIs) and diagnostic testing [8, 9]. GERD can affect patients’ health-related quality of life and associated with an increased risk of esophagitis, esophageal strictures, Barrett’s esophagus, and esophageal adenocarcinoma. Gastroesophageal reflux is primarily a disorder of the lower esophageal sphincter, but there are other factors that contribute to its development. The main symptoms of GERD are heartburn and regurgitation. However, GERD can present with a variety of other extraesophageal symptoms. Typical symptoms of GERD are often sufficient to establish the diagnosis, and such patients can be empirically prescribed a proton pump inhibitor. Endoscopy, esophageal manometry, and esophageal pH monitoring are recommended for patients who do not respond to such treatment or if the diagnosis is unclear. Lifestyle changes, medications, and surgery are the main treatment options for GERD.