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Gastroesophageal reflux disease.

G W Falk1

  • 1Center for Swallowing and Esophageal Disorders, Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. falkg@cesmtp.ccf.org

Current Opinion in Gastroenterology
|October 7, 2006
PubMed
Summary

Gastroesophageal reflux disease (GERD) involves transient lower esophageal sphincter relaxations, influenced by nitric oxide and cholinergic pathways. Helicobacter pylori may offer protection against GERD complications.

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Area of Science:

  • Gastroenterology
  • Digestive Diseases

Background:

  • Gastroesophageal reflux disease (GERD) is a prevalent clinical condition.
  • Transient lower esophageal sphincter relaxation is a key factor in GERD pathogenesis.
  • Nitric oxide and cholinergic pathways are newly identified modulators of transient lower esophageal sphincter relaxation.

Purpose of the Study:

  • To review recent advancements in understanding GERD pathogenesis and treatment.
  • To explore the role of Helicobacter pylori in GERD.
  • To discuss diagnostic and therapeutic strategies for GERD.

Main Methods:

  • Literature review of recent studies on GERD.
  • Analysis of the role of specific molecular pathways (nitric oxide, cholinergic).
  • Evaluation of diagnostic (endoscopy, empiric PPI trial) and therapeutic (PPIs, surgery) approaches.

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Main Results:

  • Helicobacter pylori infection may protect against GERD complications.
  • Nocturnal acid breakthrough during proton pump inhibitor (PPI) therapy is a potential treatment concept.
  • Laparoscopic antireflux surgery is cost-effective for patients needing long-term PPI therapy.

Conclusions:

  • GERD management involves understanding complex pathogenetic pathways.
  • Diagnostic and therapeutic decisions in GERD should be individualized.
  • Surgical intervention for GERD, particularly laparoscopic antireflux surgery, remains a viable option.