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2014 ; 76
(6
): 453-60
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Gastroesophageal reflux disease: diagnosis and patient selection
#MMPMID25614720
Singhal V
; Khaitan L
Indian J Surg
2014[Dec]; 76
(6
): 453-60
PMID25614720
show ga
Gastroesophageal reflux disease (GERD) has a high prevalence worldwide. Recent
reports have noted a high prevalence even in Asian countries. GERD significantly
affects the quality of life and can present with a wide variety of symptoms. Not
all reflux is acid, and non-acid reflux disease can be more difficult to diagnose
and can lead to a variety of extra-esophageal symptoms. Although proton pump
inhibitors (PPIs) are effective in the majority of patients, but they are not
without side effects, and their effect often diminishes with time. For patients
who do not desire to be on long-term PPIs or have incomplete symptom resolution
with medication, various endoscopic and minimally invasive treatment modalities
are now available. The etiology of GERD can be multifactorial including
dysfunctional LES, presence of a hiatal hernia, and transient lower esophageal
sphincter relaxations (TLESRs). We hence believe that the treatment should be
individualized to the cause of the reflux. In the following review, we describe
the etiology of reflux disease and attempt to lay a framework for the diagnosis
and selection of patients for the various interventions available for treatment,
along with their evidence base.