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GERD 2003 - A consensus on the way ahead

Citation

Moss, SF and Armstrong, D and Arnold, R and Ferenci, P and Fock, KM and Holtmann, G and McCarthy, DM and Moraes-Filho, JP and Mutschler, E and Playford, RJ and Spechler, SJ and Stanghellini, V and Modlin, IM, GERD 2003 - A consensus on the way ahead , Digestion: International Journal of Gastroenterology, 67, (3) pp. 111-117. ISSN 0012-2823 (2003) [Refereed Article]

DOI: doi:10.1159/000071290

Abstract

Gastroesophageal reflux disease (GERD) has in recent times become an important public health issue owing to the considerable health care resources utilized in its management, its deleterious effect on quality of life and the increasing prevalence of a relatively rare complication of reflux disease - esophageal adenocarcinoma. We review here the major current challenges in the field of reflux disease and its complications, and provide some approaches that may be useful in management. The issues to be faced include the very limited comprehension of the reasons behind the increasing prevalence of the disease, difficulties in correlating symptoms with objective data of pathological gastroesophageal reflux and the relatively unsophisticated tools we are employing to investigate the underlying pathophysiology. It is certain that the lack of well-defined and characterized methodologies to compare the effects of therapy require the development of more effective questionnaire-type analytic tools. In regard to treatment, there is little doubt that the widely prescribed proton pump inhibitors have dose-equivalent efficacy and are the most highly effective agents capable of suppressing acid, controlling many of the symptoms of GERD and healing erosions. Nevertheless, many patients continue to experience symptoms on withdrawal or at night. Pharmacological agents that can effectively increase lower esophageal sphincter pressure or promote motility are as yet unavailable. Although the introduction of laparoscopic techniques has resulted in a modest revival in surgical intervention using a variety of 'wrap-type' operations, the indications are few and the procedure is associated with a significant morbidity and even mortality especially if the expertise of the surgeon is an issue. Endoscopic techniques of regulating reflux are at this time experimental and not applicable to the general population. Intestinal metaplasia in the lower esophagus is probably very common. Whether and how to, first, screen for, and then, perform surveillance in Barrett's esophagus remains highly problematic and contentious. Copyright © 2003 S. Karger AG, Basel.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Gastroenterology and Hepatology
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Digestive System Disorders
Author:Playford, RJ (Professor Ray Playford)
ID Code:72910
Year Published:2003
Web of Science® Times Cited:34
Deposited By:Research Division
Deposited On:2011-09-02
Last Modified:2011-10-03
Downloads:0

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