Current opinion in gastroenterology vol:12 issue:4 pages:365-372
As in other years, literature on gastroesophageal reflux disease (GERD) in 1995 was abundant and mainly focused on the underlying pathophysiologic mechanisms and its treatment. Twenty-four hour recording of lower esophageal sphincter pressure confirmed that transient lower esophageal sphincter relaxations are the main underlying mechanism during reflux episodes. The role of the crural diaphragm in preventing gastroesophageal reflux was stressed; dysfunction of this mechanism might be important in the pathogenesis of GERD. Also, new insights in the role of gastroduodenal reflux in GERD were reported in studies combining pH monitoring and bilirubin measurement using a new fiber-optic probe. In a subgroup of patients with GERD symptoms correlated with reflux but with negative 24-hour pH monitoring studies, visceral hypersensitivity was introduced as the underlying mechanism. Several maintenance therapies were compared for treatment of reflux esophagitis. Long-term profound acid suppression might need Helicobacter pylori eradication, whereas further safety follow-up remains warranted. Abundant studies showed positive results of laparoscopic surgery with results comparable to open surgery.