The Pattern of Esophageal Acid Exposure in Gastroesophageal Reflux Disease Influences the Severity of the Disease

Open Access
Publisher Website
Google Scholar
Abstract
RECENT STUDIES have shown that the prevalence and severity of gastroesophageal reflux disease (GERD) are increasing.1-4 This is true despite dramatic improvements in the efficacy of treatment options. This "epidemic" increase is at least partially explained by factors such as dietary changes, improved diagnostic techniques, increased awareness, and the widespread availability and use of upper endoscopy. Despite this explanation, there is serious concern that the present therapeutic approach to GERD may not be adequate and the traditional stepwise approach, in which successively more efficacious therapies are used following failure of the previous treatment, deserves reassessment. Ideally, decisions regarding the most appropriate medical or surgical therapy are based on an understanding of the underlying disease severity and the probability of future complications.5,6 This is particularly true in the approximately 50% of patients who present without evidence of esophagitis or other signs of mucosal injury.7-9 Identifying risk factors associated with severe disease allows the clinician to tailor the therapeutic approach prior to the development of complications.