Shu-Wei Lianga, Ming‑Wun Wonga,b, Chih‑Hsun Yia, Tso‑Tsai Liua, Wei‑Yi Leia, Jui‑Sheng Hunga, Lin Lina, Benjamin D. Rogersc,d, Chien‑Lin Chena,e*
aDepartment of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan, bSchool of Post‑Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan, cDivision of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA, dDivision of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA, eInstitute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Gastroesophageal reflux disease (GERD) is very common and defined as troublesome symptoms owing to excessive acid reflux. The spectrum of GERD is broad, including not only erosive esophagitis and Barrett’s esophagus but also nonerosive reflux disease (NERD), reflux hypersensitivity, and functional heartburn. Patients with reflux symptoms despite normal endoscopy remain common clinical presentation, can be heterogeneous overlapping with functional gastrointestinal disorders. Ambulatory esophageal pH monitoring with and without impedance helps the diagnosis of NERD. Metrics such as baseline impedance and postreflux swallow induced peristaltic wave enhance diagnostic accuracy in patients with inconclusive diagnoses. The major treatment of all manifestations of GERD is acid suppression with proton pump inhibitors, while other therapies, such as reflux‑reducing agents and adjunctive medications, can be individualized where the response to traditional management is incomplete. GERD patients often need long‑term treatment due to frequent relapses. Anti‑reflux surgery can be effective too. Endoscopic therapies have some promising results, but long‑term outcomes remain to be determined.
Keywords: Gastroesophageal reflux disease, Impedance‑pH, Proton pump inhibitors
