Diagnosis of gastroesophageal reflux: an update on current and emerging modalities

Abstract

Gastroesophageal reflux disease (GERD) is a common condition characterized by troublesome symptoms or esophageal mucosal lesions attributed to excessive esophageal acid exposure. Various pathophysiological mechanisms account for GERD, including impaired esophageal peristalsis and anatomical or physiological defects at the esophagogastric junction (EGJ). Endoscopy identifies GERD complications and detects potential alternative diagnoses. However, if symptoms persist despite proton pump inhibitor therapy, functional esophageal tests are useful to characterize reflux burden and define the symptom association profile. Ambulatory pH or pH‐impedance monitoring measures the 24‐h acid exposure time, which remains the most reproducible reflux metric and predicts response to antireflux therapy. Apart from identifying peristaltic dysfunction, esophageal high‐resolution manometry defines the morphology and contractile vigor (EGJ‐CI) of the EGJ. Novel metrics obtained from pH‐impedance monitoring include the postreflux swallow–induced peristaltic wave index and mean nocturnal baseline impedance, which augment the diagnostic value of pH‐impedance testing. Mucosal impedance can also be recorded using a probe inserted through a gastroscope, or a novel balloon catheter with arrays of impedance electrodes inserted following sedated endoscopy. The latest developments in functional esophageal tests define the GERD phenotype based on pathogenesis, reflux exposure, structural or motility disorders, and symptom burden, facilitating appropriate treatment.

BTS Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability

“…Objective measures, including 24-hour multichannel intraluminal impedance with single or dual channel pH measurement and endoscopy with oesophageal biopsy, are recommended for the diagnosis of GORD particularly in patients with neurodisability or where accurate evaluation of a significant response to proton pump inhibitor (PPI) therapy is not possible 125. High-resolution oesophageal manometry can be used for further elucidation of GORD pathophysiology particularly if there is clinical concern regarding possible oesophageal dysmotility 126. Extraoesophageal biomarkers such as lipid-laden macrophages and bronchoalveolar lavage pepsin are not diagnostically helpful 127.…”

Current Advancement on the Dynamic Mechanism of Gastroesophageal Reflux Disease

“…Additionally, with the popularization of HRM technology, more attention has been paid to the GERD mechanism of esophageal motility disorders. IEM, as a newly proposed type of esophageal dynamic disorder, plays an important role in the esophageal dynamic characteristics of GERD, the selection of treatment methods, and the elaboration of its pathogenesis [118][119][120].…”

Tata Laksana <i>Gastroesophageal Reflux Disease</i> dalam Masa Pandemi Covid

“…GERD juga merupakan penyebab umum kasus-kasus noncardiac chest pain (NCCP), sehingga penting untuk membedakan antara nyeri dada yang mungkin disebabkan karena gangguan jantung atau yang disebabkan oleh etiologi lain berdasarkan algoritma diagnosis agar dapat memberikan penanganan yang tepat. 12 Meskipun gejala umum GERD sangat mudah dikenali, manifestasi extraesophageal juga sering terjadi, akan tetapi tidak selalu dikenali.…”

“…Dispepsia adalah entitas yang mungkin ditangani secara berbeda dari GERD dan mungkin memerlukan evaluasi endoskopi, termasuk uji Helicobacter pylori. 12…”

“…Investigasi lebih lanjut diperlukan saat terjadi kegagalan dalam terapi yang diberikan, diagnosis yang tidak pasti, dan adanya komplikasi yang dialami. Investigasi lanjutan dapat berupa endoskopi, esophageal HRM, disertai dengan kontrol pH pasien dengan rawat jalan 12 Diagnosis GERD umumnya berdasarkan klasifikasi Montreal dan yang terbaru menggunakan Konsensus Lyon.…”