Pathophysiology and pharmacological treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist's practice. Gastroesophageal reflux describes the r etrograde movement of gastric contents through the lower esophageal sphinct er (LES) to the esophagus. It is a common, normal phenomenon which may occu r with or without accompanying symptoms. Symptoms associated with GERD incl ude heartburn, acid regurgitation, noncardiac chest pain, dysphagia, globus pharyngitis, chronic cough, asthma, hoarseness, laryngitis, chronic sinusi tis and dental erosions. The introduction of fiberoptic instruments and amb ulatory devices for continuous monitoring of esophageal pH (24-hour pH moni toring) has led to great improvement in the ability to diagnose reflux dise ase and reflux-associated complications. The development of pathological re flux and GERD can be attributed to many factors. Pathophysiology of GERD in cludes incompetent LES because of a decreased LES pressure, transient lower esophageal sphincter relaxations (TLESRs) and deficient or delayed esophag eal acid clearance. Uncomplicated GER may be treated by modification of lif e style and eating habits in an early stage of GERD. The various agents cur rently used for treatment of GERD include mucoprotective substances, antaci ds, H-2 blockers, prokinetics and proton pump inhibitors. Although these dr ugs are effective, they do not necessarily influence the underlying causes of the disease by improving the esophageal clearance, increasing the LESP o r reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological trea tment of GERD. Copyright (C) 2000 S. Karger AG, Basel.