Gastro-Oesophageal Reflux Disease

Abstract

New approaches to the grading of reflux oesophagitis and the definition of reflux disease have been proposed which should improve the precision of descriptions of this common problem. Endoscopy and 24-hour pH monitoring studies, though of great value, have significant limitations for assessment of reflux disease. Only about one third of reflux disease patients have oesophageal mucosal erosion or ulceration. Analysis of symptoms is probably the most useful method for diagnosis. Further research is needed into the best strategies for maximising the potential of symptom analysis. In the pathogenesis of reflux disease, Helicobacter pylori infection is not a major factor but the interaction of H. pylori gastritis and eradication therapy are important areas of great current interest. Troublesome reflux disease arises primarily from abnormally frequent gastro-oesophageal reflux, though heightened oesophageal mucosal sensitivity and defective oesophageal clearance play a role in some patients. Transient lower oesophageal sphincter relaxation appears to be the most important mechanism of reflux. This distinctive, swallow-independent type of lower oesophageal sphincter relaxation has a complex triggering system, apparently located in the brain stem. Medical and surgical treatments of reflux disease are now well characterised and have improved very substantially over recent years. Drugs that inhibit the occurrence of transient lower oesophageal sphincter relaxation are an intriguing possible future therapy.

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

“…24,25 Postprandial heartburn drives millions of Americans to seek antireflux treatment on a daily basis. However, the currently available therapeutic modalities are not fast or effective enough to provide good control of postprandial heartburn.…”

Association between Body Mass Index and Gastroesophageal Reflux Symptoms in Nepalese Adult Population. A Single Centered Hospital Based Study

“…Only about one third of patients with reflux disease have endoscopically detectable signs of reflux. 19 Reflux symptoms are considered to be main tool of gastro-esophageal reflux disease. 20,21 Analysis of the main symptoms, heartburn and regurgitation, is probably the most useful method for diagnosing this condition.…”

“…20,21 Analysis of the main symptoms, heartburn and regurgitation, is probably the most useful method for diagnosing this condition. 19 Improper classification of GERD might have driven to lack of association in our 14 grade of disease severity. This study has been preformed with its some limitation which should be acknowledged.…”

Evaluation of 24-hour oesophageal pH monitoring in children with food allergy

“…Pathological reflux is characterized by increased frequency and intensity of episodes of acid regurgitation into the oesophagus and the occurrence of symptoms from other organs (gastroesophageal reflux disease). It occurs in children with an incidence of 1 : 100 to 1 : 300, according to different authors, and depends on age, coexisting diseases, and genetic, ethnic and racial factors [5,7,16,[18][19][20].…”