Recent advances in diagnostic testing for gastroesophageal reflux disease.
Gastroesophageal reflux disease (GERD) has a large economic burden with important complications that include esophagitis, Barrett's esophagus, and adenocarcinoma. Despite endoscopy, validated patient questionnaires, and traditional ambulatory pH monitoring, the diagnosis of GERD continues to be challenging. Areas covered: This review will explore the difficulties in diagnosing GERD with a focus on new developments, ranging from basic fundamental changes (histology and immunohistochemistry) to direct patient care (narrow-band imaging, impedance, and response to anti-reflux surgery). We searched PubMed using the noted keywords. We included data from full-text articles published in English. Further relevant articles were identified from the reference lists of review articles. Expert commentary: Important advances in novel parameters in intraluminal impedance monitoring such as baseline impedance monitoring has created some insight into alternative diagnostic strategies in GERD. Recent advances in endoscopic assessment of esophageal epithelial integrity via mucosal impedance measurement is questioning the paradigm of prolonged ambulatory testing for GERD. The future of reflux diagnosis may very well be without the need for currently employed technologies and could be as simple as assessing changes in epithelia integrity as a surrogate marker for GERD. However, future studies must validate such an approach.
a Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders , Vanderbilt University Medical Center , Nashville , TN , USA.
Rishi D
RD
Naik
a Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders , Vanderbilt University Medical Center , Nashville , TN , USA.
Michael F
MF
Vaezi
D015415:Biomarkers / Q000032:analysis; D003938:Diagnostic Techniques, Digestive System / Q000639:trends*; D004059:Diffusion of Innovation; D017097:Electric Impedance; D050782:Esophageal pH Monitoring / Q000639:trends; D004945:Esophagoscopy / Q000639:trends; D004947:Esophagus / Q000737:chemistry / Q000473:pathology / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry / Q000639:trends; D062048:Narrow Band Imaging / Q000639:trends; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results
D015415:Biomarkers
Gastroesophageal reflux disease; anti-reflux surgery; baseline impedance; biomarkers; dilated intracellular space; heartburn; intraluminal impedance; mucosal impedance; post-reflux swallow-induced peristaltic wave (PSPW) index; proton pump inhibitor