Diagnosis and management of gastroesophageal reflux disease

Abstract

IntroductionGastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals.ObjectiveTo update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it.MethodThe literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication.ResultsVarious factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications.ConclusionGERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and esophageal pHmetry are the most sensitive diagnosctic methods. The clinical treatment is useful in controlling the symptoms; however, the great problem is keeping the patients asymptomatic over time. Surgical treatment is indicated for patients who required continued drug use, intolerant to the drugs and with complicated forms of GERD.

Radiofrequency ablation is safe and effective in the treatment of Chinese patients with gastroesophageal reflux disease: A single‐center prospective study

“…Gastroesophageal reflux disease (GERD) is a common gastrointestinal disease characterized by the reflux of gastric contents into the esophagus . GERD affects seriously the patient's quality of life, because it may induce the occurrence of reflux esophagitis (RE), esophageal strictures, and even esophageal adenocarcinomas .…”

Endoscopic Findings Related To Helicobacter Pylori

“…Fundic gland polyps, red streaks and normal mucosal appearance correlate with the negativity of HP infection. The other forms, diffuse nonspecific erythema or redness of antrum and body and flat erosions, were not conclusive of the presence or absence of HP [24][25][26][27][28][29][30][31][32][33][34][35].…”

Dexlansoprazole – a new-generation proton pump inhibitor

“…A particularly intensive treatment suppressing the secretion of gastric acid is necessary in patients with severe erosive oesophagitis (grades C and D according to the Los Angeles classification, in which coalescing epithelial erosions involve a considerable part or the entire oesophageal circumference). Healing such severe lesions requires a powerful suppressive effect on the secretion of acidic gastric juice using fixed therapeutic doses in maintenance treatment, because the incidence of recurrence of erosive oesophagitis in this form of GERD exceeds 90% during 6 months [ 2 , 12 , 16 , 17 ].…”

“…It is known that some GERD patients (17–35%) treated with omeprazole or other proton pump inhibitors continue experiencing symptoms of the disease [ 17 – 20 ]. Studies show that up to 35.4% of patients and 34.8% of physicians are not fully satisfied with the outcome of treatment based on traditional PPIs [ 21 ].…”