Update on the diagnostic evaluation and medical management of reflux esophagitis

Symptoms of GERD may be mild and episodic and occur without esophagitis, whereas severe disease is usually associated with erosive esophagitis, esophageal ulceration and, eventually, chronic complications such as stricture, bleeding, and anemia. Prolonged exposure of the esophageal mucosa to gastric acid may also lead to histopathologic mutations such as Barrett esophagus, which may increase the risk of esophageal adenocarcinoma. Technological innovations have enhanced our understanding of diagnostic investigation and clinical management of GERD. The recently introduced techniques of DGER testing, wireless pH monitoring, and esophageal impedance recording have provided more sensitive and specific diagnostic tools for GERD, which are particularly useful in patient subsets such as those refractory to PPI therapy. Combined MII-pH testing is more sensitive than pH monitoring alone for the detection of nonacid reflux events associated with regurgitant reflux symptoms that persist on PPI therapy. PPIs are the most effective pharmacologic agents to ensure effective control of intragastric pH. Profound gastric acid inhibition is warranted to heal reflux esophagitis, especially in more severe disease. Patients with reflux esophagitis commonly require long-term PPI maintenance therapy. Maintenance therapy may also have an important role in preventing complications, such as the development of a stricture or dysplasia in Barrett esophagus.