The spectrum of gastroesophageal reflux disease

The 3 major effects of gastroesophageal reflux disease (GERD) are (1) esophageal symptoms and injury, (2) Barrett esophagus, and (3) pulmonary symptoms, including asthma and pneumonia. Esophageal symptoms and injury, for the most part, have been well-managed with the use of proton-pump inhibitors (PPIs). Indeed, the introduction of PPIs have very likely changed for the better the natural history of GERD. Barrett esophagus remains a problem despite the availability of PPIs. Although the symptoms of GERD are well controlled in patients with GERD and Barrett's, the development of esophageal cancer remains, as of now, a problem. Pulmonary symptoms, including asthma and pneumonia, remain a major problem. When the method is found that predicts which patients with GERD and pulmonary symptoms will respond to antireflux treatment, the results could be profound: fewer hospitalizations for respiratory complications, less pulmonary morbidity and mortality, less need for pulmonary medications, less time lost from work, fewer visits to a physician's office, and less illness associated with corticosteroid therapy. For the present time, however, clinical judgment and good sense are still our best friends. It is not unreasonable to urge our patients to alter lifestyle: the huge volume, calorie dense, high fat meals that are eaten before bedtime are not likely to prevent GERD or add to our life expectancy.