Reflux disease: the disorder of the third millennium

Gastro-oesophageal reflux disease (GORD) affects a large group of patients and has a negative impact on quality of life. In addition, this disorder is associated with considerable long-term morbidity and mortality. In Western countries, between 10% and 30% of the population is affected by GORD. Symptoms of GORD include retrosternal burning and regurgitation, which are highly predictive of acid exposure to the oesophageal mucosa. However, erosions or ulcers in the oesophageal mucosa occur in fewer than 30% of patients with this disorder as assessed by current endoscopic techniques. Treatment of symptoms in this patient population is nonetheless of paramount importance. Current data indicate that the prevalence of GORD is increasing in the population as a whole. Although the exact reasons for this increase are unknown, changes in diet and lifestyle may play some role. Furthermore, a decreasing prevalence of Helicobacter pylori infection in the population, which is thought to exert some protection against GORD, may also be involved. Along with the increasing prevalence of GORD is an increase in GORD-related complications, including Barrett's oesophagus and oesophageal adenocarcinoma. Given the delay in onset of these GORD-associated complications, these findings are particularly alarming. As these trends continue, current techniques for the treatment of GORD will need to be refined and reevaluated in terms of quality-of-life issues, health care utilization, and cost-efficacy. Treatment of GORD in the future will require effective techniques to control symptoms, maintain remission, and prevent complications in the affected patient.