Gastro Esophageal Reflux Disease (GERD) Pathogenesis, Diagnosis and Therapy

Gastro esophageal reflux disease (GERD) is a common chronic disorder that is associated with a huge economic burden in the many countries and significantly decreased quality of life. Nearly all epidemiologic studies have found an association between increasing body mass index (BMI) and symptoms of gastro esophageal reflux disease (GERD). Changes in gastro esophageal anatomy and physiology caused by obesity may explain the association. These include an increased prevalence of esophageal motor disorders, diminished lower esophageal sphincter (LES) pressure, the development of a hiatal hernia, and increased intragastric pressure. GERD can lead to complications that include esophageal stricture and esophageal adenocarcinoma. Multiple challenges are associated with GERD treatment. First, lack of symptoms does not correlate with the absence of or the healing of esophageal lesions. Second, proton pump inhibitors, the current standard of care for GERD, are ineffective for the majority of GERD patients who have nonerosive disease. Investigations and technical advances have enhanced our understanding and management of gastro esophageal reflux disease. The recognition of the prevalence and importance of patients with endoscopy-negative reflux disease as well as those refractory to proton pump inhibitor therapy have led to an increasing need for objective tests of esophageal reflux. This review focuses on the various multicultural issues in the epidemiology, pathophysiology, diagnosis, and treatment of GERD