Exploring the spectrum of GERD: myths and realities

Abstract

Concepts of the spectrum of gastroesophageal reflux disease
(GERD) continue to evolve as researchers and clinicians challenge
conceptual frameworks and explore new paradigms
aided by innovative technologies and novel developments
in symptom assessment. In this review, the deliberations of
a meeting of experts in gastroenterology (Athens, 2006) are
presented as a critical evaluation of the current understanding
of GERD and its symptoms, and an exploration of future
directions. Consensus statements from Genval, Marrakesh
and Montreal present working definitions of GERD; these
will, inevitably, continue to be refined as our understanding
of the spectrum of GERD-associated symptoms evolves and
our appreciation of differences among non-erosive reflux
disease (NERD), erosive GERD and Barrett's esophagus, as
well as the overlap between GERD and functional gastrointestinal
disorders (FGIDs), grows. Currently, we lack an
independent basis by which to determine whether particular
symptoms are a manifestation of GERD per se or should
be attributed to associated FGIDs. Furthermore our understanding
of the etiology of atypical manifestations and extraesophageal
symptoms is poor. It is possible that, in the
future, acid-related NERD will become identifiable in terms
of a microscopic inflammatory or ultrastructural change in
the esophageal epithelium, thereby allowing a diagnosis of
microscopic erosive reflux disease. It is likely that the natural
history of GERD will be confirmed as largely benign and
biomarkers will identify the minority who may be destined
for a more sinister outcome. Finally, developments in symptom
assessment will continue to improve our understanding
of GERD and, ultimately, better predict treatment outcomes
for patients.
Key Words: gastroesophageal reflux disease; GERD; symptom
relief; PPI; ReQuestTM; functional gastrointestinal disorders;
extraesophageal symptoms