2013, Number 2
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Rev Med MD 2013; 4.5 (2)
Diagnostic guide for gastroesophageal reflux disease
Velarde-Ruiz-Velasco JA, Rodríguez-Chávez JL, González-Rodríguez CI, Mora-Huerta JA
Language: Spanish
References: 30
Page: 87-93
PDF size: 624.04 Kb.
ABSTRACT
Gastroesophageal reflux disease (GERD) is defined as the rise of gastric or gastro-duodenal content above
gastroesophageal junction which can cause bothersome symptoms and/ or structural damage, which can impact
quality of life and wellbeing of patients suffering from it. Worldwide prevalence ranges from 10 to 20% and it seems to
be rising, probably due to factors like and overall increase of over weight and obesity in general population. Three
phenotypic types of GERD have been described: 1. Non erosive GERD (NERD) defines as the presents of
symptomatology and absence of erosions of the mucous layer of the esophagus as demonstrated by white light
endoscopy; 2. Erosive GERD, in which superficial erosive damage or rupture of esophageal mucous layer can be
visualized by white light endoscopy; 3. Barrett's esophagus, defined as specialized intestinal metaplasia in the
esophagus. Diagnosis of GERD is suggestive when the typical symptoms of pyrosis and regurgitation are present;
however these findings do not have diagnostic certainty in some patients, which is why it has been proposed that GERD
diagnoses be made with both the combination of symptoms, objective endoscopy testing, ambulatory reflux monitoring
and response to anti-secretory treatment. Upper digestive tract endoscopy is not necessarily required in the presence of
typical symptoms of GERD and is only recommended when signs of alarm are present or in patients who have high
risk of presenting complications. Ambulatory monitoring of GERD is preferred prior to considering endoscopic or
surgical therapy in patients with NERD, as well part of evaluation of patient not responding to therapy with proton
pump inhibitors (PPI) and in cases in which GERD diagnosis is not certain.
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