GASTROESOPHAGEAL REFLUX DISEASE: MODERN DIAGNOSTIC AND TREATMENT STRATEGIES
Keywords:
Gastroesophageal reflux disease, GERD, proton pump inhibitor, Lyon Consensus, pH-impedance monitoring, Barrett's esophagus, fundoplication, magnetic sphincter augmentation, refractory GERD.Abstract
Background: Gastroesophageal reflux disease (GERD) is one of the most common conditions encountered in outpatient practice worldwide, arising from pathologic retrograde flow of gastric contents into the esophagus, and ranges in presentation from typical heartburn and regurgitation to extraesophageal manifestations and, in chronic uncontrolled disease, Barrett's esophagus and esophageal adenocarcinoma.
Methods: This narrative review synthesizes current evidence on the diagnosis and management of GERD, drawing on the 2022 American College of Gastroenterology (ACG) clinical guideline, the 2022 American Gastroenterological Association (AGA) clinical practice update, and the Lyon Consensus criteria for objective diagnosis of pathologic reflux.
Results: For patients with typical symptoms and no alarm features, an 8-week empiric trial of once-daily proton pump inhibitor (PPI) therapy remains the recommended initial approach, while endoscopy is reserved for those with alarm symptoms, risk factors for Barrett's esophagus, or an inadequate response to empiric therapy. When endoscopy is unrevealing and diagnostic uncertainty remains, ambulatory pH-impedance monitoring performed off antisecretory therapy, interpreted using Lyon Consensus metrics, provides objective confirmation or exclusion of pathologic reflux. Management is stepwise: lifestyle modification and PPI optimization form the foundation of therapy, while esophageal manometry and consideration of surgical or endoscopic antireflux procedures — laparoscopic fundoplication, magnetic sphincter augmentation, or transoral incisionless fundoplication — are reserved for patients with objective evidence of GERD that remains refractory to optimized medical therapy.
Conclusion: Modern GERD care depends on correctly distinguishing between refractory symptoms and true refractory GERD before escalating therapy, and on reserving invasive testing and procedures for patients in whom pathologic reflux has been objectively confirmed rather than assumed; this stepwise, evidence-based approach is both effective and readily adaptable to resource-limited settings such as Uzbekistan, where empiric PPI therapy and basic endoscopy remain the most widely available diagnostic and therapeutic tools.
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