Diagnosis and treatment of gastroesophageal reflux disease.

[esophageal adenocarcinoma]

Gastroesophageal reflux disease (GERD ) is a common disease with a prevalence as high as 10 %-20 % in the western world . The disease can manifest in various symptoms which can be grouped into typical , atypical and extra -esophageal symptoms . Those with the highest specificity for GERD are acid regurgitation and heartburn . In the absence of alarm symptoms , these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy . In certain situations , further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms . GERD complications include erosive esophagitis , peptic stricture , Barrett 's esophagus , esophageal adenocarcinoma and pulmonary disease . Management of GERD may involve lifestyle modification , medical therapy and surgical therapy . Lifestyle modifications including weight loss and /or head of bed elevation have been shown to improve esophageal pH and /or GERD symptoms . Medical therapy involves acid suppression which can be achieved with antacids , histamine-receptor antagonists or proton-pump inhibitors . Whereas most patients can be effectively managed with medical therapy , others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation . The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease .