Review article
Gastroesophageal Reflux Disease
Roland Pulanić
Abstract
Gastroesophageal refl ux disease (GERD) is
a common illness, especially in western population, with a
spectrum of symptoms and signs produced by the gastric and
duodenal content refl ux to the esophagus, mouth and airways.
GERD causes considerable impairment of the patient’s quality
of life thus posing a socioecononic problem. The mortality rate
is low in spite of the high prevalence and chronic course of
GERD. The ever growing interest in this basically benign disease
is underlain by the strong causal relationship of GERD with the
occurrence of esophageal adenocarcinoma and extraesophageal
organ diseases such as asthma, laryngitis, otitis, sinusitis,
sleep apnea, etc. GERD is predominantly caused by incompetent
antirefl ux barrier due to disruption with the development
of hiatal hernia, or transitory relaxation of lower esophageal
sphincter. Asthma, chronic cough or laryngitis, as the most common
extraesophageal forms of GERD, occur due to direct mucosal
damage by acid and pepsin, microaspiration or vagal refl ex
mechanism. The diagnosis of GERD is based on history data,
endoscopy, and in some cases pH metry. Barrett’s esophagus,
as a major complication of GERD, is detected by endoscopy and
verifi ed by histology of esophageal mucosal lesions. As GERD is
an acid dependent disease, proton pump inhibitors produce the
best therapeutic effects. These agents are used initially or “on
demand” or at long term, depending on GERD severity, endoscopic
fi nding and extraesophageal organ lesions. As not all
patients with Barrett’s esophagus will develop adenocarcinoma,
those at a high risk should be timely identifi ed. Discovery of the
respective molecular markers may potentially help in this issue.
At present, there is no consensus on the indications for operative
treatment of GERD. Operative therapy, preferably laparoscopic
fundoplication performed by experienced surgeons at
large centers, generally produces favorable results. This therapy
is reserved for strictly selected patients. Endoscopic or endoluminal
antirefl ux therapy is in the experimental phase, and the
success of these methods in the management of GERD can only
be confi rmed by properly controlled studies.
Keywords
gastroesophageal refl ux disease; epidemiology; pathophysiology; diagnosis; therapy
Hrčak ID:
18849
URI
Publication date:
26.1.2006.
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