Current opinion in gastroenterology vol:11 issue:4 pages:380-387
The abundant literature on gastroesophageal reflux disease (GERD) in 1994 was again mainly focused on the underlying pathophysiologic mechanisms of this disorder and its treatment. Dysfunction of the lower esophageal sphincter and hiatal hernia are well-established mechanisms in the pathogenesis of CERD. Motility disturbances of the esophageal body are clearly present in patients with GERD; however, whether they result from a primary esophageal motor disorder or are secondary to reflux esophagitis remains unclear. Apparently, traction force measurement seems more appropriate than conventional manometry to study motility disturbances in (mild forms of) GERD. There is increasing interest in the detection of bile reflux and its relationship to severity of esophagitis and the development of Barrett's esophagus. In addition, a new technique was introduced allowing investigation of the esophagosalivary reflex and illustrating the importance of saliva as a defense mechanism against gastroesophageal reflux. Attention was also focused on the association between GERD and respiratory symptoms, with conflicting results. New diagnostic techniques for gastroesophageal reflux, such as electrical impedance tomography and ultrasonography, were introduced, whereas the importance of radiology was reevaluated. For research purposes, ambulatory 24-hour pH-metry recordings were increasingly combined with measurement of pressure and bile reflux and with electrocardiography, obviating computer-assisted analysis. Finally, many studies, including very large prospective randomized studies, illustrated the superiority of omeprazole to H-2 blockers in the initial treatment and long-term maintenance therapy of complicated GERD. Further safety follow-up, however, remains warranted. Although follow-up is still rather limited, positive results were published on laparoscopic Nissen antireflux surgery for GERD. Controlled studies comparing it with medical treatment and conventional Nissen antireflux surgery are crucial.