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Background: Gastroesophageal reflux disease (GERD) is common. Management of reflux symptoms includes medical and nonmedical interventions. Proton pump inhibitors (PPIs) continue to be considered first-line agents. Standard investigations to diagnose GERD include upper endoscopy, impedance-pH measurement or capsule-based pH measurements and high-resolution manometry. However, diagnosis can sometimes be difficult in individual cases when measurements yield borderline results. Combination of the three mentioned techniques is considered the diagnostic gold standard now. Summary: Aside from the current measures considered gold standard, new measurement parameters, mostly focusing on impedance of the esophageal mucosa will help better diagnose GERD. Another promising new modality is the combination of wireless pH measurements and evaluation of esophageal motility and structural abnormalities using the endoscopic functional lumen imaging probe (FLIP). Artificial intelligence may play an increasingly supportive role. Key Messages: GERD needs to be better diagnosed to avoid unnecessary or potentially harmful long-term acid suppression therapy or reflux surgery. A number of tools is under investigation. However, as of now they only have supportive value.
Background: Gastroesophageal reflux disease (GERD) is common. Management of reflux symptoms includes medical and nonmedical interventions. Proton pump inhibitors (PPIs) continue to be considered first-line agents. Standard investigations to diagnose GERD include upper endoscopy, impedance-pH measurement or capsule-based pH measurements and high-resolution manometry. However, diagnosis can sometimes be difficult in individual cases when measurements yield borderline results. Combination of the three mentioned techniques is considered the diagnostic gold standard now. Summary: Aside from the current measures considered gold standard, new measurement parameters, mostly focusing on impedance of the esophageal mucosa will help better diagnose GERD. Another promising new modality is the combination of wireless pH measurements and evaluation of esophageal motility and structural abnormalities using the endoscopic functional lumen imaging probe (FLIP). Artificial intelligence may play an increasingly supportive role. Key Messages: GERD needs to be better diagnosed to avoid unnecessary or potentially harmful long-term acid suppression therapy or reflux surgery. A number of tools is under investigation. However, as of now they only have supportive value.
The article analyzes the latest ideas about the pathogenetic mechanisms of the combined formation of gastroesophageal reflux disease and obesity in young people. Special attention is paid to the role of adipose tissue hormones and nitric oxide in this process. Unresolved and controversial issues to date are noted, and prospects for further research in this direction are analyzed.
To date, there are several advanced methods for diagnosing esophageal and gastric disorders that are actively used in clinical practice, among which high-resolution (HR) manometry stands out. This innovative study provides an opportunity to assess in detail the functional state of the esophagus, in particular the coordination of muscle contractions during swallowing and the function of the lower esophageal sphincter. HR manometry is an effective tool for detecting motility disorders such as achalasia, gastroesophageal reflux disease, diffuse esophageal spasm, as well as other functional disorders that can affect the process of swallowing and moving food through the esophagus. One of the main advantages of HR manometry is accurate diagnosis of functional esophageal disorders due to the use of special catheters with numerous sensors located at a short distance from each other (about 1 cm). This allows you to create detailed topographic maps of pressure in the esophagus, which show the contraction of its muscles in real time. Thanks to this high resolution, it is possible to detect even minor motility disorders that previously went unnoticed when using traditional diagnostic methods. HR manometry has significantly improved the diagnosis of achalasia due to the ability to clearly identify three subtypes of this disease (classic achalasia, pan-esophageal pressure, and spastic achalasia). This allows doctors not only to make a more accurate diagnosis, but also to choose the optimal treatment strategy adapted to the specific type of disorder. In case of gastroesophageal reflux disease, HR manometry helps assess the function of the lower esophageal sphincter and diaphragm, which is important for detecting diaphragmatic weakness, which is one of the main causes of pathological reflux. In addition, this method makes it possible to diagnose concomitant peristalsis disorders that affect the ability of the esophagus to clear from acid reflux, thereby helping doctors better understand the mechanism of the disease and prescribe more effective treatment. Thus, HR manometry has a key place among modern methods for diagnosing esophageal disorders, allowing not only to accurately detect motility disorders, but also to optimize treatment. This significantly improves patients’ quality of life, as it helps doctors choose the most effective therapeutic strategies based on accurate data about esophageal function.
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