Treatment of GERD complications (Barrett's, peptic stricture) and extra-oesophageal syndromes

Apart from typical reflux symptoms and oesophagitis the clinical presentation of GERD can be dominated by mucosal complications of reflux (Barrett s oesophagus oesophageal adenocarcinoma Peptic structure) or by extra-oesophageal syndromes most notably asthma laryngitis or chronic cough Managing these entities is much less straightforward than with oesophagitis With respect to adenocarcinoma metaplasia and dysplasia are recognised precursors but the potential of these lesions to evolve to cancer has not been shown to lessen as a result of treatment medical or surgical Consequently management focuses on strategies to identify and eliminate high-grade dysplasia and intra-mucosal cancer lesions that are potentially curable by endoscopic ablation or surgical resection With respect to the extra-oesophageal GERD syndromes these are increasingly recognised as multifactorial conditions with reflux as in exacerbating factor Treatment trials have been generally disappointing and the clinical challenge remains in accurately identifying afflicted patients who might benefit from more intensive medical or surgical reflux treatment Published by Elsevier Ltd