Novel developments in non-erosive and erosive gastroesophageal reflux disease

Abstract

Despite being clinically important and highly prevalent, several aspects of gastroesophageal reflux disease are incompletely understood. Research activity remains high, however, and we shall review some highlights from last year's publications. Community based epidemiological studies have elucidated the risk factors for gastroesophageal reflux disease and demonstrated a significant risk for developing complications over time. New histological parameters such as distended intercellular spaces in the epithelium will detect minor signs of reflux damage. The esophageal endoscopic capsule has been studied as a way of screening for esophageal disease. Wireless pH-metry and impedance-pH-metry have increased our insight into the pathophysiology and improved the diagnostic work-up in atypical and therapy resistant cases. At the molecular level, the role of cytokines has been elucidated and there is increased support for the nitrosative stress theory for epithelial damage at the cardia. Endoscopic therapies have shown disappointing long-term results or safety concerns, leading to withdrawal of several methods. The last year has brought significant development in diagnostic modalities, and increased our insight in the molecular events involved in the pathogenesis of gastroesophageal reflux disease. Ultimately, this may and must lead to new therapeutic modalities which will supplement proton pump inhibitors in medical therapy for gastroesophageal reflux disease.