Recent Trends in the Management of Gastroesophageal Reflux Disease

Although GERD is a common disorder, diagnosis is still imprecise (Karmanolis and Sifrim, 2007). Recent diagnostic guide lines address the use of endoscopy, ambulatory reflux monitoring and esophageal manometry (De Vault and Castell, 2005).Multichannel intraluminal impedance (MII) is a new technique for evaluating gastroesophagealreflux independent of the acidity. It detects the retrograde movement of the esophageal intraluminal bolus by means of two electrodes placed in the esophagus (Weigt et al., 2007). Combined MII-pH monitoring presents a new paradigm for reflux testing particularly non-acid reflux which is no longer detected primarily by pH monitoring (Castell et al., 2005).As such, acid suppression is the main stay of therapy for GERD, including proton pump inhibitors (PPIs) and histamine 2-receptor blockers given in divided doses may be effective in some patients with less severe GERD.Promtility agents may be used too as an adjunct to acid suppression in selected patients.Other agents include Tegaserod (a 5-HT3 agonist) and Baclofen( a γ-Aminobutyric acid receptor agonist) have both been reported to improve GERD manifestations (De Vault and Castell, 2005).The surgical treatment of GERD implies a 360-degree wrap of the gastric fundus around the lower end of the esophagus (Nissen, 1956). Other modifications included partial anterior wrapping (Dor et al., 1962) and a 270-degree posterior wrap (Toupet, 1963). The development of minimally invasive surgical techniques has led to a dramatic increase in the number of antireflux operations being performed (Stylopoulos and Rattner, 2005).