Gastroesophageal Reflux Disease – An Update

Gastroesophageal reflux disease (GERD) is a common disease and a considerable burden on healthcare resources. Definitions and terminology have been a source of confusion for GERD. The ‘Montreal definition’ is the first ever global consensus definition of GERD. The esophageal and extraesophageal syndromes are now considered the two constituent syndromes of GERD. The pathogenesis of gastroesophageal reflux is multi-factorial and a failure of the anti-reflux barrier allowing the stomach content to enter the esophagus is the target of interest. Heartburn and acid regurgitation are the typical symptoms of the disease, although some patients may have atypical manifestations of GERD. The long term complication of GERD includes esophageal stricture, Barrett’s esophagus with consequent increase in the risk of esophageal adenocarcinoma. Diagnosis of GERD can usually be established on the basis of a careful history and physical examination. Detailed diagnostic studies are not necessary in a patient presenting with typical symptoms with no alarming features. Patients with alarming feature in addition to their GERD symptoms require prompt investigation and usually endoscopy is preferred. Treatment of GERD is directed at acid suppression through the use of lifestyle modifications and pharmacologic agents from over-the-counter (OTC) agents ranging from antacids to proton pump inhibitors (PPIs). New algorithm of treatment of GERD has also been proposed. Antireflux surgery, including open and laparoscopic, and newer endoscopic procedures are alternative modalities of treatment in case of failure of medical therapy.