GERD and its complications.

Gastroesophageal reflux disease (GERD) is the condition that results when gastric material that refluxes into the esophagus or oropharynx causes symptoms, tissue injury, or both. Endoscopic examination usually is not required merely to establish a diagnosis of GERD, but endoscopy is the best diagnostic test for Barrett's esophagus, a sequela of GERD that predisposes to esophageal adenocarcinoma. Patients found to have Barrett's esophagus will require regular endoscopic surveillance for early, curable neoplasia. Esophageal pH monitoring is useful for patients who have symptoms or signs suggestive of GERD, but who have little or no response to antisecretory therapy. For patients who have severe, ulcerative reflux esophagitis, the clinician has only two reasonable therapeutic options: (1) lifelong antisecretory therapy with proton pump inhibitors or (2) antireflux surgery. There are no absolute indications for antireflux surgery, but the operation can be considered for patients with severe GERD who are unwilling to accept lifelong medical therapy or for young patients whose GERD symptoms respond only to proton pump inhibitors administered in high dosages.