Gastroesophageal reflux disease in the 21st century

Gastroesophageal reflux disease (GERD) is a chronic disorder affecting a significant proportion of the global population, characterized by heartburn and regurgitation, and potentially associated with serious complications such as esophagitis, Barrett's esophagus, and adenocarcinoma. Its multifactorial pathophysiology includes alterations in the lower esophageal sphincter, motility, or visceral sensitivity. Diagnosis is based on a combination of clinical criteria and complementary tests such as endoscopy, pH monitoring, and impedance testing. Management includes non-pharmacological strategies like lifestyle and dietary changes, along with pharmacological therapy, with proton pump inhibitors being the cornerstone of treatment. Newer options, such as potassium-competitive acid blockers (vonoprazan), have shown promising benefits in refractory cases. This article synthesizes the most updated evidence on GERD, providing a comprehensive overview of its pathophysiology, diagnosis, and therapeutic options.