Identifying the Causes of Reflux Events and Symptoms — New Approaches
Fox M. Aliment Pharmacol Ther. 2011.
Gastro-oesophageal reflux disease (GERD) is present if the passage of gastric contents back into the oesophagus causes either mucosal disease or symptoms. The aim of clinical investigation in patients with suspected GERD is not only to establish the diagnosis, but also to identify underlying pathology and guide specific management. Unfortunately, standard endoscopy and physiological measurement of oesophageal function by manometry and ambulatory pH measurement rarely meet these ideals. The need to improve clinical management of patients, especially those with endoscopy negative disease and symptoms persisting during acid-suppressive therapy has refocused attention on the pathophysiology of disease. This review summarises new approaches and new technologies that have been introduced for the investigation of GERD. These include high-resolution endoscopy, detection of dilated intercellular spaces on histology, combined pH impedance studies, prolonged wireless pH monitoring, detection of aerosolized acid in the pharynx, detection of pepsin in expectorated saliva, measurement of gastro-oesophageal distensibility and monitoring of gastro-oesophageal function after a meal by high resolution manometry. The potential role of these advances to improve clinical practice is considered. Throughout, emphasis is given to the need to identify underlying causes of reflux events and symptoms and how the findings of investigation could be used to guide rational and effective treatment.