Clinical course of gastroesophageal reflux disease and impact of treatment in symptomatic young patients

Luigi Bonavina, P. Marco Fisichella, Sravanya Gavini, Yeong Yeh Lee, Roger P. Tatum

Research output: Contribution to journalReview articlepeer-review

Abstract

In symptomatic young patients with gastroesophageal reflux symptoms, early identification of progressive gastroesophageal reflux disease (GERD) is critical to prevent long-term complications associated with hiatal hernia, increased esophageal acid and nonacid exposure, release of proinflammatory cytokines, and development of intestinal metaplasia, endoscopically visible Barrett's esophagus, and dysplasia leading to esophageal adenocarcinoma. Progression of GERD may occur in asymptomatic patients and in those under continuous acid-suppressive medication. The long-term side effects of proton-pump inhibitors, chemopreventive agents, and radiofrequency ablation are contentious. In patients with early-stage disease, when the lower esophageal sphincter function is still preserved and before endoscopically visible Barrett's esophagus develops, novel laparoscopic procedures, such as magnetic and electric sphincter augmentation, may have a greater role than conventional surgical therapy. A multidisciplinary approach to GERD by a dedicated team of gastroenterologists and surgeons might impact the patients’ lifestyle, the therapeutic choices, and the course of the disease. Biological markers are needed to precisely assess the risk of disease progression and to tailor surveillance, ablation, and management.

Original languageEnglish (US)
Pages (from-to)117-126
Number of pages10
JournalAnnals of the New York Academy of Sciences
Volume1481
Issue number1
DOIs
StatePublished - Nov 10 2020

Keywords

  • Barrett's esophagus
  • crural diaphragm
  • esophageal adenocarcinoma
  • gastroesophageal reflux disease
  • laparoscopic fundoplication
  • lower esophageal sphincter
  • proton-pump inhibitors

ASJC Scopus subject areas

  • Neuroscience(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • History and Philosophy of Science

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