Advances in the diagnosis and management of gastroesophageal reflux disease

Abstract

Gastroesophageal reflux disease (GERD) is a multifaceted disorder encompassing a family of syndromes attributable to, or exacerbated by, gastroesophageal reflux that impart morbidity, mainly through troublesome symptoms. Major GERD phenotypes are non-erosive reflux disease, GERD hypersensitivity, low or high grade esophagitis, Barrett’s esophagus, reflux chest pain, laryngopharyngeal reflux, and regurgitation dominant reflux. GERD is common throughout the world, and its epidemiology is linked to the Western lifestyle, obesity, and the demise of Helicobacter pylori. Because of its prevalence and chronicity, GERD is a substantial economic burden measured in physician visits, diagnostics, cancer surveillance protocols, and therapeutics. An individual with typical symptoms has a fivefold risk of developing esophageal adenocarcinoma, but mortality from GERD is otherwise rare. The principles of management are to provide symptomatic relief and to minimize potential health risks through some combination of lifestyle modifications, diagnostic testing, pharmaceuticals (mainly to suppress or counteract gastric acid secretion), and surgery. However, it is usually a chronic recurring condition and management needs to be personalized to each case. While escalating proton pump inhibitor therapy may be pertinent to healing high grade esophagitis, its applicability to other GERD phenotypes wherein the modulating effects of anxiety, motility, hypersensitivity, and non-esophageal factors may dominate is highly questionable.

Letter: proton pump inhibitor use and bone fracture risk—a mechanistic point of view

“…However, significant associations between PPI use and bone fracture risk were detected in relatively young adults (age 51‐60: OR 1.66; age 61‐70: OR 1.83) but not older adults (age 71‐80: OR 1.10; age >80: OR 1.22), and in men (OR 1.63) but not in women (OR 1.18). These results are compatible with the suggestion that the impact of PPI use on bone fracture risk seems to be limited 3 …”

“…There is debate on the safety of proton pump inhibitors (PPIs), including whether long‐term use causally increase bone fracture risk 1‐3 . In a population‐based case‐control study of adult patients with cirrhosis using the Disease Analyzer database (1795 cases and 10 235 controls), Labenz et al 4 recently found that PPI use was dose‐dependently associated with an increased risk of bone fractures.…”

“…An increase in falling would be an important risk factor in patients with cirrhosis as the authors discussed 4 . By contrast, on the basis of the result from a meta‐analysis of association between PPI use and fall risk (OR 1.27), long‐term use of PPIs appears to have a minimal impact 3 . It is therefore unclear if PPI use can further increase the fall risk in those with cirrhosis who already have an increased risk of falls.…”

Study on the Value of C1q in the Diagnosis of Esophageal Cancer

“…The common treatments were chemotherapy, chemoradiotherapy and surgical resection [15,16] . Reflux disease is associated with an increased risk of esophagitis, esophageal strictures, Barrett esophagus, and esophageal adenocarcinoma, and it has the similar symptoms to EC [17,18] . Using endoscopy can distinguish EC from reflux disease, though some patients refuse this way to check their esophagus [19] .As a result, a blood biomarker which can help to diagnose EC from reflux disease come to be important.…”

Refractory Gastroesophageal Reflux Disease: Surgical Perspective from a Multi-Disciplinary Practice

“…3 Sorting out which symptoms are actually caused by GERD can be vexing, especially for the atypical symptoms. 4 Therefore, at our center we careful correlate symptoms with objective testing to insure that an ARS will lead to symptomatic and pathologic improvement, with minimal side effects.…”