Gastroesophageal reflux disease and pH monitoring

Advances have been made in our understanding of the abnormalities of the lower esophageal sphincter and stomach that may initiate reflux, disorders of motility that may impair clearance of reflux material, and defense mechanisms that may protect the mucosa. There is growing interest in the association between gastroesophageal reflux disease and respiratory disorders, with clinical studies indicating its importance and physiologic studies providing insights into possible underlying mechanisms. The field of ambulatory pH monitoring continues to develop: in adults, the major advances relate to refining the indications for its use, whereas in children it has also been necessary to modify and then validate the techniques developed initially in adults. The most notable advance concerning treatment of gastroesophageal reflux disease has been the widespread availability of omeprazole. Its clinical efficacy has been established and the problem that now remains is to define the benefit-risk ratio for its use in different circumstances. The outcome of appropriate studies will be of the utmost importance for gastroesophageal reflux disease patients and will have considerable implications for the future of antireflux surgery and also the pharmaceutical industry.