Gastroesophageal reflux disease--state of the art

Gastroesophageal reflux disease (GERD) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus; heartburn, its most common manifestation, occurs in 7% to 10% of the U.S. population on a daily basis. In addition, many so-called extraesophageal or atypical symptoms, including chronic cough, laryngitis and other otolaryngologic conditions, asthma, and unexplained chest pain, can be associated with GERD, but these patients appear to have a decreased frequency of heartburn, making the diagnosis of GERD difficult. All patients can be successfully managed with appropriate, titrated use of pharmacologic therapy. Antireflux surgery should thus be considered as an option only for patients who cannot afford or choose not to continue long-term medical therapy and for the rare patient with side effects or resistance to proton pump inhibitors. Endoscopic therapy for reflex should be considered as an experimental technology needing continuing evaluation.