Gastroesophageal reflux disease, pH monitoring, and treatment

Gastroesophageal reflux disease is a chronic, relapsing condition. The mechanisms underlying the development of gastroesophageal reflux disease and reflux esophagitis remain obscure although work continues on the roles of transient relaxations of the lower esophageal sphincters, the crural diaphragm, hiatus hernia, esophageal clearance, and mucosal defense. Endoscopy is the primary diagnostic procedure for the detection of esophagitis. There have been no technical advances with respect to esophageal pH monitoring, but evaluation procedures are being refined to allow identification of adult patients whose symptoms are attributable to gastroesophageal reflux episodes or acidification. In children, pH monitoring continues to be used to identify infants at risk of sudden infant death who might benefit from antireflux surgery and to identify the cause of persistent respiratory problems. There is further evidence for an association between gastroesophageal reflux and respiratory disease in patients with cystic fibrosis, but more studies are required to define the extent to which gastroesophageal reflux provokes respiratory symptoms. Omeprazole is the most effective medical treatment for the treatment of reflux esophagitis, and recent studies have shown that maintenance therapy will prevent relapse in most patients with no evidence, to date, of any serious adverse effects. Further studies are required to define the place of conservative measures, antisecretory agents, and surgery in the treatment of gastroesophageal reflux disease and, in the current economic climate, such studies must be combined with some form of cost-benefit analysis.