Recognizing nonerosive reflux disease (NERD) as a distinct presentation of gastroesophageal reflux disease (GERD) was one of the most important developments in the field of GERD in the last decade. Whilst the definition of NERD has not changed significantly over the years, the disorder accounts for the majority of the GERD patients and those who failed proton pump inhibitor (PPI) treatment. Recent developments in NERD focused primarily on understanding the pathophysiology and natural history. The introduction of esophageal impedance + pH has led to the assessment of other forms of gastroesophageal reflux in causing NERD. Therapeutic modalities still focus on acid suppression, but there is growing recognition that other therapeutic strategies should be considered in NERD.
Electric Impedance ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Natural History ; Proton Pumps

No abstract available.
Gastroesophageal Reflux ; Rome

No abstract available.

In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pump inhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia, odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett’s esophagus screening; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical anti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to medical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopy with white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (narrow-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocal laser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure, transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosectomy, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of the new endoscopic techniques are not widely available, and their use is limited to centers of excellence.

Extraesophageal symptoms and signs of gastroesophageal reflux disease (GERD), such as throat clearing, globus sensation, hoarseness, cough, asthma, pulmonary fibrosis, otitis, sinusitis, and dental erosions, are common and pose diagnostic and therapeutic challenges. Proton pump inhibitors (PPIs) are the mainstay of treatment for GERD, but have demonstrated a limited effectiveness for extraesophageal symptoms and signs in several meta-analyses. Potassium-competitive acid blockers (P-CABs) offer more rapid and sustained acid inhibition than PPIs; therefore, P-CABs may have the potential to be at least as good or superior to PPIs in relieving extraesophageal symptoms and signs of GERD. To date, there have been 4 prospective randomized trials demonstrating similar efficacy of P-CABs to PPIs in the treatment of extraesophageal symptoms and signs, but more rapid and greater efficacy in patients with severe symptoms. Therefore, P-CABs appear to have a treatment role in extraesophageal symptoms and signs of GERD. However, considering that P-CABs are not superior to PPIs, large-scale, multi-center studies with double dose P-CABs over a prolonged period of time may elucidate a subgroup of patients in whom P-CABs are beneficial in ameliorating extraesophageal symptoms and signs.

Extraesophageal symptoms and signs of gastroesophageal reflux disease (GERD), such as throat clearing, globus sensation, hoarseness, cough, asthma, pulmonary fibrosis, otitis, sinusitis, and dental erosions, are common and pose diagnostic and therapeutic challenges. Proton pump inhibitors (PPIs) are the mainstay of treatment for GERD, but have demonstrated a limited effectiveness for extraesophageal symptoms and signs in several meta-analyses. Potassium-competitive acid blockers (P-CABs) offer more rapid and sustained acid inhibition than PPIs; therefore, P-CABs may have the potential to be at least as good or superior to PPIs in relieving extraesophageal symptoms and signs of GERD. To date, there have been 4 prospective randomized trials demonstrating similar efficacy of P-CABs to PPIs in the treatment of extraesophageal symptoms and signs, but more rapid and greater efficacy in patients with severe symptoms. Therefore, P-CABs appear to have a treatment role in extraesophageal symptoms and signs of GERD. However, considering that P-CABs are not superior to PPIs, large-scale, multi-center studies with double dose P-CABs over a prolonged period of time may elucidate a subgroup of patients in whom P-CABs are beneficial in ameliorating extraesophageal symptoms and signs.

Extraesophageal symptoms and signs of gastroesophageal reflux disease (GERD), such as throat clearing, globus sensation, hoarseness, cough, asthma, pulmonary fibrosis, otitis, sinusitis, and dental erosions, are common and pose diagnostic and therapeutic challenges. Proton pump inhibitors (PPIs) are the mainstay of treatment for GERD, but have demonstrated a limited effectiveness for extraesophageal symptoms and signs in several meta-analyses. Potassium-competitive acid blockers (P-CABs) offer more rapid and sustained acid inhibition than PPIs; therefore, P-CABs may have the potential to be at least as good or superior to PPIs in relieving extraesophageal symptoms and signs of GERD. To date, there have been 4 prospective randomized trials demonstrating similar efficacy of P-CABs to PPIs in the treatment of extraesophageal symptoms and signs, but more rapid and greater efficacy in patients with severe symptoms. Therefore, P-CABs appear to have a treatment role in extraesophageal symptoms and signs of GERD. However, considering that P-CABs are not superior to PPIs, large-scale, multi-center studies with double dose P-CABs over a prolonged period of time may elucidate a subgroup of patients in whom P-CABs are beneficial in ameliorating extraesophageal symptoms and signs.

Noncardiac chest pain is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause. Noncardiac chest pain is a prevalent disorder resulting in high healthcare utilization and significant work absenteeism. However, despite its chronic nature, noncardiac chest pain has no impact on patients' mortality. The main underlying mechanisms include gastroesophageal reflux, esophageal dysmotility and esophageal hypersensitivity. Gastroesophageal reflux disease is likely the most common cause of noncardiac chest pain. Esophageal dysmotility affects only the minority of noncardiac chest pain patients. Esophageal hypersensitivity may be present in non-GERD-related noncardiac chest pain patients regardless if esophageal dysmotility is present or absent. Psychological co-morbidities such as panic disorder, anxiety, and depression are also common in noncardiac chest pain patients and often modulate patients' perception of disease severity.
Absenteeism ; Anxiety ; Chest Pain ; Delivery of Health Care ; Depression ; Esophageal Motility Disorders ; Esophagus ; Gastroesophageal Reflux ; Heart ; Heartburn ; Humans ; Hypersensitivity ; Panic Disorder ; Thorax

Background/Aims: Presently, there is paucity of information about clinical predictors, especially esophageal motor abnormalities, for long segment Barrett’s esophagus (LSBE) as compared with short segment Barrett’s esophagus (SSBE). The aims of this study are to compare the frequency of esophageal function abnormalities between patients with LSBE and those with SSBE and to determine their clinical predictors. Methods: This was a multicenter cohort study that included all patients with a diagnosis of BE who underwent high-resolution esophageal manometry. Motility disorders were categorized as hypercontractile disorders or hypocontractile disorders and their frequency was compared between patients with LSBE and those with SSBE. Multivariable logistic regression modeling was used to calculate the odds of being diagnosed with LSBE relative to SSBE for demographics, comorbidities, medication use, endoscopic findings, and the type of motility disorders. Results: A total of 148 patients with BE were identified, of which 89 (60.1%) had SSBE and 59 (39.9%) LSBE. Patients with LSBE had a significantly larger hiatal hernia and higher likelihood of erosive esophagitis than patients with SSBE (P = 0.002). Patients with LSBE had a significantly lower mean LES resting pressure, distal contractile integral, distal latency, and significantly higher failed swallows and hypocontractile motility disorders than those with SSBE (P < 0.05). Hiatal hernia and hypocontractile motility disorder increased the odds of LSBE by 38.0% and 242.0%, as opposed to SSBE. Conclusions The presence of a hypocontractile motility disorder increased the risk for LSBE. Furthermore, the risk for LSBE was directly associated with the length of the hiatal hernia.

No abstract available.
Esophageal Achalasia* ; Esophagus*