Gastroesophageal Reflux Disease
The prevalence of gastroesophageal reflux disease in the Western world is rising and is now up to 20%. The main etiological factors are an incompetent anti reflux barrier and/or unsuccessful luminal clearance mechanisms. Gastroesophageal reflux disease can be divided into three groups: 70% of patients have the non-erosive form, 30% the erosive form, and 10% of former patients with the erosive form also have complications. Heartburn and acid regurgitation are typical symptoms of the disease. Atypical symptoms are caused by acid microaspiration or vasovagal reflex mechanisms, and are as follows: water brash, dysphagia, odynophagia, chronic cough, noncardiac chest pain, bronchial asthma and teeth erosion. Testing with a proton pump inhibitor, upper gastrointestinal endoscopy, continuous ambulatory pH monitoring and esophageal monometry are the most widely used diagnostic tests. Proton pump inhibitors are the drug of choice in the therapy of gastroesophageal reflux disease. Patients are also advised on lifestyle modifications. 80% of the patients will experience a relapse within a year of stopping medical therapy. The long term management of gastroesophageal reflux disease is comprised of on-demand therapy with a proton pump inhibitor or permanent therapy with the same drug. The possibilities for surgical treatment are also described, as well as principles of cancer surveillance in patients with Barrett’s esophagus.