Diagnosis of Gastroesophageal Reflux Disease (GERD)

Abstract

BACKGROUND: Gastroesophageal reflux disease (GERD) affects approximately 20–40% of individuals in Europe and North America and represents a disorder associated with "losses" (loss of life quality, esophageal function and morphology). METHODS: Review of level of evidence III–IV papers on diagnosis of GERD. RESULTS: GERD symptoms (heartburn, regurgitation, dysphagia, cough, wheezing) are associated with pathologic acidic and/or nonacidic gastroesophageal reflux, impaired esophageal motility and lower esophageal sphincter function and pathologic morphology: stricture, ulcus, ring web formation; columnar lined esophagus (CLE); intestinal metaplasia (i.e. Barrett esophagus) which may progress towards dysplasia and adenocarcinoma of the esophagus. Symptom correlation with data obtained by combined pH- and intraluminal impedance monitoring represents a sensitive tool for assessment of presence or absence of GERD and should be offered to those with GERD symptoms and normal pH-monitoring. Endoscopy should include biopsy sampling of a normal appearing esophago-gastric junction for exclusion of microscopic CLE with or without intestinal metaplasia and/or dysplasia. The value of high-resolution manometry for diagnosis of GERD is still under investigation. CONCLUSIONS: Patient history, physical examination and assessment of life quality are of major importance for diagnosis of GERD. Novel technologies have profoundly contributed towards those responsible being able to ascertain whether symptoms are in fact being caused by gastroesophageal reflux.