Diagnosis and management of gastroesophageal reflux disease

What is it about?

Gastroesophageal reflux disease (GERD) was a term devised to conceptualize the array of symptoms and potential complications that can occur from the excessive reflux of gastric content into the esophagus. In general, GERD develops through a combination of age-related change and the increased abdominal pressure associated with abdominal obesity. However, translating the concept of GERD into practice had led to much confusion and several contradictions in how the "disease" is diagnosed and managed. This article analyzes these contradictions and how they have led to large scale over-diagnosis and over-treatment of GERD.

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Why is it important?

The major drug class used to treat GERD are the proton pump inhibitors (PPIs). Because of large scale over-diagnosis and over-treatment of GERD, these have become among the most commonly prescribed and used drugs in the world. This has resulted in massive population exposure on the assumption that the drugs are perfectly safe. However, no drug is perfectly safe and the past 5 years have seen a steady stream of reports associating chronic PPI use with a wide array of potentially serious conditions including bone fracture, chronic kidney disease, dementia, nutrient deficiencies and infections.

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