Management of reflux esophageal disease

Although frequent or prolonged exposure of the esophageal mucosa to gastric contents results in epithelial damage, it is also becoming clear that the pathophysiology of reflux esophageal disease may be multifactorial. The severity of this disease may relate to the frequency of reflux episodes, certainly to the duration of mucosal exposure to refluxed material, and probably to as yet unquantified factors of mucosal resistance and the specific noxiousness of refluxed gastroduodenal and pancreatic secretions. The phenomenon of esophageal clearance is a critical determinant in preservation of mucosal integrity, and a disturbance in this function may lead to severe signs and symptoms of reflux esophageal disease. A detailed analysis of the specific pathophysiologic abnormalities in individual patients may permit more "tailored" therapeutic approaches and more favorable results.