Acid-Suppression Therapy for Gastroesophageal Reflux Disease and the Therapeutic Gap

Abstract

Abstract Medical management of gastroesophageal reflux disease (GERD) has hinged on the principle that adequate acid suppression leads to improvement in symptoms attributable to acid reflux. In the absence of mucosal manifestations of GERD (i.e., erosive esophagitis, Barrett metaplasia, adenocarcinoma) and in light of imperfect pH testing and symptom correlation, the success of treatment does not always correlate with improvement in symptoms. As such, the term refractory GERD, which has traditionally referred to persistence of mucosal disease in spite of proton pump inhibitor (PPI) therapy, has now evolved to define failure of symptomatic response for potential GERD symptoms. Moreover, with multiple recent epidemiologic studies raising concerns over possible adverse events associated with long-term PPI use, both patients and clinicians are wary of continued PPI use, and interest in nonpharmacologic alternatives to GERD management has substantially increased. This review highlights the need for different therapies to bridge this therapeutic gap, while providing a comprehensive review of alternative medical and behavioral treatments, along with novel endoscopic therapies and surgical approaches to GERD.