Modern Diagnosis and Management of Acid-Related Disorders

Acid-related disorders are among the most common and costly suffered by gastroenterology patients. Substantial evolution has occurred in the care of these patients. This review summarizes major advances in some of the most common acid-related disorders, including gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR), peptic ulcer disease (PUD) and Helicobacter pylori (Hp) infection, and Barrett's esophagus (BE). Major technical and conceptual breakthroughs, including multiday pH measurement, endoscopic eradication therapy (EET) for BE, and modern diagnostic paradigms for GERD and LPR have streamlined patient identification and simplified management. Given increasing antimicrobial resistance, optimal management of Hp infection and related PUD has changed. The rapidly-evolving place of potassium-competitive acid blockers (P-CABs) in the care of patients with acid-related disorders is considered. Central themes in patient care include a move away from empiric therapy and toward diagnostic algorithms that define both the cause of the condition and the degree and duration of therapy necessary to treat it. Also, diagnosis and therapy are increasingly being personalized based on symptom profile and adjunct diagnostic data from an increasingly complex armamentarium of modalities. Therapeutic algorithms demonstrate the appropriate use of many of the technologies noted above in the care of patients with acid-related disorders.