GASTROESOPHAGEAL REFLUX DISEASE

In 1996, several important studies advanced our understanding in the f ield of gastroesophageal reflux disease. Studies confirmed the importa nce of transient lower esophageal sphincter relaxations in the pathoge nesis of gastroesophageal reflux disease and further found that this p henomenon is not associated with inhibition of esophageal body contrac tility. Supine posture and right recumbent positions were observed to be important in esophageal acid exposure. Also, new insights into the role of duodenal contents and esophageal mucosal injury were reported in studies using the new ambulatory bilirubin monitoring device, These studies found that acid reflux is accompanied by the simultaneous ref lux of duodenal contents, with both being important in the development of mucosal damage and Barrett's esophagus. Additionally, studies show ed that aggressive acid suppression, normalizing 24-hour esophageal pH values, results in 100% healing of esophagitis; however, due to indiv idual variation in gastric acidity, some patients may require doses of omeprazole greater than 40 mg daily. Finally, several studies found t hat laparoscopic antireflux surgery is effective and safe in the hands of experienced surgeons, although long-term results await the course of time and future studies.