editorial diagnosis and management of gastroesophageal...

Hindawi Publishing CorporationGastroenterology Research and PracticeVolume 2013, Article ID 709620, 2 pageshttp://dx.doi.org/10.1155/2013/709620

EditorialDiagnosis and Management of Gastroesophageal Reflux Disease

Ping-I Hsu,1 Nayoung Kim,2 Khean Lee Goh,3 and Deng-Chyang Wu4

1 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital,National Yang-Ming University, Kaohsiung 813, Taiwan

2Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital,Seoul National University, Republic of Korea

3 Department of Medicine, University of Malaysia, Kuala Lumpur, Malaysia4Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan

Correspondence should be addressed to Ping-I Hsu; [email protected]

Received 25 September 2013; Accepted 25 September 2013

Copyright © 2013 Ping-I Hsu et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gastroesophageal reflux disease (GERD) is one of the mostcommon disorders in medical practice. It is the mostcommon gastrointestinal diagnosis recorded during visitsto outpatient clinics in the United States. Apart from theeconomic burden of the disease and its impact on qualityof life, GERD is the most common predisposing factor foresophageal adenocarcinoma [1].

Recently, many important issues have emerged regardingthe classification, pathogenesis, natural history, and treat-ment of GERD.Although use of proton-pump inhibitor (PPI)is the treatment of choice forGERD, approximately, one-thirdof patients with GERD fail to response symptomatically to astandard-dose proton-pump inhibitor (PPI), either partiallyor completely [2]. Additionally, most GERD patients needlong-term treatment for frequent relapses after discontinuingacid inhibition therapy. This has led to great interest in newendoscopic therapies for the treatment of this disease. Withregard to the diagnosis of GERD, patients with refractoryreflux symptoms and normal upper endoscopy are moredifficult to diagnose and treat. Combined 24-hour pH andimpedance monitoring allows classifying the patients ashaving true nonerosive reflux disease (NERD), hypersensitiveesophagus, or functional heartburn and is helpful for furthermanagement of the patients [3].

The main focus of this special issue is on recent advancesin the treatment of erosive esophagitis, NERD and Barrett’sesophagus. In addition, the emerging diagnostic methods,pharmacological treatments, and endoscopic therapies forGERD are also discussed.

The paper entitled “The frequencies of gastroesophagealand extragastroesophageal symptoms in patients with milderosive esophagitis, severe erosive esophagitis, and Barrett’sesophagus, in Taiwan” is the first work simultaneously assess-ing the differences in reflux symptom profiles among thethree different categories of GERD.The data showed that thefrequencies of some esophageal and extraesophageal symp-toms in patients with Los Angeles grade A/B erosive esoph-agitis were higher than those in patients with Los Angelesgrade C/D erosive esophagitis and Barrett’s esophagus.

In the paper entitled “Current pharmacological manage-ment of gastroesophageal reflux disease,” Y.-K. Wang et al.present the current and developing therapeutic agents forGERD treatment. The efficacies of PPIs and potassium-competitive acid blocker in GERD therapy are well reviewed.Additionally, the article summarizes the development ofnovel therapeutic agents focusing on the underlying mech-anisms of GERD.

In the paper entitled “Pharmacological therapy of gastroe-sophageal reflux in preterm infants,” L. Corvaglia et al. reviewthe pathogenesis, presentation, diagnosis, and treatmentof gastroesophageal reflux in preterm infants. A stepwiseapproach is advisable for the treatment of gastroesophagealreflux in preterm infants, firstly, promoting nonpharmaco-logical interventions and secondly, limiting drugs to selectedinfants unresponsive to the conservative measures or whoare suffering from severe gastroesophageal refluxwith clinicalcomplications.

2 Gastroenterology Research and Practice

In the paper entitled “Stretta radiofrequency treatment forGERD: a safe and effective modality,” M. Franciosa et al. focuson the safety, efficacy, and durability of the Stretta radiofre-quency treatment for GERD therapy. The novel endoscopictreatment reduces esophageal acid exposure, decreases thefrequency of transient lower esophageal relaxation, decreasesmedication use and improves quality of life inGERDpatients.

In the paper entitled “Duodenal tube feeding: an alterna-tive approach for effectively promoting weight gain in childrenwith gastroesophageal reflux and congenital heart disease,” S.Kuwata et al. showed that duodenal tube feeding improvesthe weight gain of infants with gastroesophageal reflux whoneed treatment for congenital-heart-disease-associated heartfailure.

In the paper entitled “Changes in ghrelin-related factorsin gastroesophageal reflux disease in rats,” M. Nahata et al.examined gastrointestinal hormone profiles and functionalchanges in ratswithGERD.The results suggest that aberrantlyincreased secretion of peripheral ghrelin and decreasedghrelin responsiveness may occur in GERD rats.

In the paper entitled “Surgical management of pediatricgastroesophageal reflux disease,” H. T. Jackson and T. D.Kane review the clinical presentation of GERD in pediatricpopulation and discuss the options for surgical managementand outcome in these patients.

In the paper entitled “Current advances in the diagnosisand treatment of nonerosive reflux disease,” C. L. Chen and P. I.Hsu, review the literature about the pathogenesis, natural his-tory, diagnosis and treatment of NERD. The authors suggestthat a combination of 24-hour esophageal impedance and pHmonitoring is indicated to differentiate acid-reflux-relatedNERD, weakly acid reflux-related NERD (hypersensitiveesophagus), nonacid-reflux-related NERD, and functionalheartburn in patients with poor response to appropriate PPItreatment.

In the paper entitled “Antireflux endoluminal therapies:past and present,” K. C. Yew et al. and S.-K. Chuah review,highlight, and discuss three commonly employed antirefluxendoluminal procedures: fundoplication or suturing tech-niques (EndoCinch, NDO, EsophyX), intramural injection orimplant techniques (enhancing LES volume and/or strength-ening compliance of the LES-EnteryX, Gatekeeper), andradiofrequency ablation of lower esophageal sphincter andcardia (the Stretta system).

Ping-I HsuNayoung Kim

Khean Lee GohDeng-Chyang Wu

References

[1] J. Lagergren, R. Bergstrom, A. Lindgren, and O. Nyren, “Symp-tomatic gastroesophageal reflux as a risk factor for esophagealadenocarcinoma,” The New England Journal of Medicine, vol.340, no. 11, pp. 825–831, 1999.

[2] R. Carlsson, J. Dent, R. Watts et al., “Gastro-oesophageal refluxdisease in primary care: an international study of differenttreatment strategies with omeprazole,” European Journal of

Gastroenterology and Hepatology, vol. 10, no. 2, pp. 119–124,1998.

[3] E. Savarino, P. Zentilin, R. Tutuian et al., “The role of nonacidreflux in NERD: lessons learned from impedance-pH mon-itoring in 150 patients off therapy,” The American Journal ofGastroenterology, vol. 103, no. 11, pp. 2685–2693, 2008.

Submit your manuscripts athttp://www.hindawi.com

Stem CellsInternational

Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014

Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinson’s Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

editorial diagnosis and management of gastroesophageal...

Documents