PMID- 25583739
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20150521
LR  - 20220409
IS  - 1469-0756 (Electronic)
IS  - 0032-5473 (Print)
IS  - 0032-5473 (Linking)
VI  - 91
IP  - 1071
DP  - 2015 Jan
TI  - Republished: symptomatic reflux disease: the present, the past and the future.
PG  - 46-54
LID - 10.1136/postgradmedj-2013-306393rep [doi]
AB  - The worldwide incidence of GORD and its complications is increasing along with 
      the exponentially increasing problem of obesity. Of particular concern is the 
      relationship between central adiposity and GORD complications, including 
      oesophageal adenocarcinoma. Driven by progressive insight into the epidemiology 
      and pathophysiology of GORD, the earlier belief that increased gastroesophageal 
      reflux mainly results from one dominant mechanism has been replaced by acceptance 
      that GORD is multifactorial. Instigating factors, such as obesity, age, genetics, 
      pregnancy and trauma may all contribute to mechanical impairment of the 
      oesophagogastric junction resulting in pathological reflux and accompanying 
      syndromes. Progression of the disease by exacerbating and perpetuating factors 
      such as obesity, neuromuscular dysfunction and oesophageal fibrosis ultimately 
      lead to development of an overt hiatal hernia. The latter is now accepted as a 
      central player, impacting on most mechanisms underlying gastroesophageal reflux 
      (low sphincter pressure, transient lower oesophageal sphincter relaxation, 
      oesophageal clearance and acid pocket position), explaining its association with 
      more severe disease and mucosal damage. Since the introduction of proton pump 
      inhibitors (PPI), clinical management of GORD has markedly changed, shifting the 
      therapeutic challenge from mucosal healing to reduction of PPI-resistant 
      symptoms. In parallel, it became clear that reflux symptoms may result from 
      weakly acidic or non-acid reflux, insight that has triggered the search for new 
      compounds or minimally invasive procedures to reduce all types of reflux. In 
      summary, our view on GORD has evolved enormously compared to that of the past, 
      and without doubt will impact on how to deal with GORD in the future.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Boeckxstaens, Guy
AU  - Boeckxstaens G
AD  - Department of Gastroenterology, Translational Research Center for 
      Gastrointestinal Disorders (TARGID), University Hospital Leuven, KU Leuven, 
      Leuven, Belgium.
FAU - El-Serag, Hashem B
AU  - El-Serag HB
AD  - Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, 
      Texas, USA.
FAU - Smout, Andre J P M
AU  - Smout AJ
AD  - Department of Gastroenterology and Hepatology, Academic Medical Centre, 
      Amsterdam, The Netherlands.
FAU - Kahrilas, Peter J
AU  - Kahrilas PJ
AD  - Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern 
      University Feinberg School of Medicine, Chicago, Illinois, USA.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Postgrad Med J
JT  - Postgraduate medical journal
JID - 0234135
RPF - Gut. 2014 Jul;63(7):1185-93. PMID: 24607936
PMC - PMC4316838
EDAT- 2015/01/15 06:00
MHDA- 2015/01/15 06:01
PMCR- 2015/02/04
CRDT- 2015/01/14 06:00
PHST- 2015/01/14 06:00 [entrez]
PHST- 2015/01/15 06:00 [pubmed]
PHST- 2015/01/15 06:01 [medline]
PHST- 2015/02/04 00:00 [pmc-release]
AID - postgradmedj-2013-306393rep [pii]
AID - 10.1136/postgradmedj-2013-306393rep [doi]
PST - ppublish
SO  - Postgrad Med J. 2015 Jan;91(1071):46-54. doi: 
      10.1136/postgradmedj-2013-306393rep.