Personalized Approach in the Work-up and Management of Gastroesophageal Reflux Disease

Gastrointest Endosc Clin N Am. 2020 Apr;30(2):227-238. doi: 10.1016/j.giec.2019.12.002. Epub 2020 Jan 22.

Abstract

Patients with gastroesophageal reflux disease (GERD) present with heterogeneous symptoms, response to treatment, and physiologic profiles, requiring distinct and personalized management. This article provides a stepwise framework to phenotype GERD beginning with (1) characterization of symptom profile and response to acid suppression; (2) endoscopic evaluation of mucosal and anatomic integrity; (3) ambulatory reflux monitoring to characterize reflux burden and sensitivity; and (4) esophageal physiologic testing to assess gastroesophageal reflux mechanism and effectors of reflux clearance, and evaluate for alternate causes.

Keywords: Esophageal manometry; Esophagitis; Functional heartburn; Hiatal hernia; Proton pump inhibitor; Reflux; Supragastric belching; Transient lower esophageal sphincter relaxation.

Publication types

  • Review

MeSH terms

  • Aged
  • Disease Management*
  • Esophageal pH Monitoring / methods
  • Female
  • Gastroesophageal Reflux / diagnosis*
  • Gastroesophageal Reflux / therapy*
  • Humans
  • Male
  • Middle Aged
  • Phenotype
  • Precision Medicine / methods*
  • Proton Pump Inhibitors / therapeutic use

Substances

  • Proton Pump Inhibitors