Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) remains one of the most common problems encountered in gastrointestinal clinical practice with over 8 million patient visits in the United States in 2009. Our understanding of the pathophysiology of this disorder has evolved considerably over the years, and the development of proton pump inhibitors almost twenty years ago radically altered both the diagnostic and the therapeutic approach to GERD. The effectiveness of this class of drugs led us to believe that we had this disease solved. However, in ensuing years it has become clear that the problem of GERD remains and the spectrum of the disease has changed to more challenging presentations, such as refractory GERD and a myriad of proposed extraesophageal manifestations. This has led to significant confusion regarding the optimal approach to these patients.

As such, the beginning of 2014 is an ideal time to address many of the evolving questions in clinical practice related to GERD, including

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What is the significance of the acid pocket?
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What is refractory GERD and what is the optimal diagnostic approach to these patients?
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What is a rational sequence for testing in patients where there is diagnostic uncertainty?
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Is nonacidic reflux really of any clinical significance?
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Is there any role for the new alternative endoscopic and surgical approaches now, given the prior limitations of endoscopic approaches to GERD?
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Are there any new medical therapies forthcoming?
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What are the implications of the obesity epidemic on the management of GERD?

To address these issues and more, Joel E. Richter, MD, one of the true giants in esophageal disease and my own valued mentor, has assembled established experts in the field to help us improve our understanding of GERD in the New Year. I think you will enjoy this issue of Gastroenterology Clinics of North America , which should enhance your approach to this common clinical problem.

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