Affiliations 

  • 1 Department of Gastroenterology, Changi General Hospital, Singapore, Singapore
  • 2 Department of Gastroenterology, Hepatology and Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
  • 3 Division of Gastroenterology and Hepatology, Stanford University, Stanford, California
  • 4 Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
  • 5 Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook University Hospital, Stony Brook, New York
  • 6 Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
  • 7 Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
Ann N Y Acad Sci, 2020 12;1481(1):154-169.
PMID: 32428279 DOI: 10.1111/nyas.14369

Abstract

Gastroesophageal reflux disease (GERD) is a common condition characterized by troublesome symptoms or esophageal mucosal lesions attributed to excessive esophageal acid exposure. Various pathophysiological mechanisms account for GERD, including impaired esophageal peristalsis and anatomical or physiological defects at the esophagogastric junction (EGJ). Endoscopy identifies GERD complications and detects potential alternative diagnoses. However, if symptoms persist despite proton pump inhibitor therapy, functional esophageal tests are useful to characterize reflux burden and define the symptom association profile. Ambulatory pH or pH-impedance monitoring measures the 24-h acid exposure time, which remains the most reproducible reflux metric and predicts response to antireflux therapy. Apart from identifying peristaltic dysfunction, esophageal high-resolution manometry defines the morphology and contractile vigor (EGJ-CI) of the EGJ. Novel metrics obtained from pH-impedance monitoring include the postreflux swallow-induced peristaltic wave index and mean nocturnal baseline impedance, which augment the diagnostic value of pH-impedance testing. Mucosal impedance can also be recorded using a probe inserted through a gastroscope, or a novel balloon catheter with arrays of impedance electrodes inserted following sedated endoscopy. The latest developments in functional esophageal tests define the GERD phenotype based on pathogenesis, reflux exposure, structural or motility disorders, and symptom burden, facilitating appropriate treatment.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.