Gastroesophageal reflux disease (
GERD) is a very common
disease, and the
prevalence in the general
population has recently increased.
GERD is a chronic relapsing
disease associated with motility disorders of the
upper gastrointestinal tract. Several factors are implicated in
GERD, including hypotensive
lower esophageal sphincter, frequent
transient lower esophageal sphincter relaxation, esophageal
hypersensitivity, reduced resistance of the
esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating
secondary peristalsis, abnormal response to multiple rapid
swallowing, and
hiatal hernia. One or more of these mechanisms result in the reflux of
stomach contents into the
esophagus, delayed clearance of the refluxate, and the development of symptoms and/or
complications. New
techniques, such as 24-hour
pH and multichannel intraluminal
impedance monitoring, multichannel intraluminal
impedance and esophageal
manometry, high-resolution
manometry, 3-dimensional high-resolution
manometry, enoscopic functional
luminal imaging probe, and 24-hour dynamic esophageal
manometry, provide more information on esophageal motility and have clarified the pathophysiology of
GERD.
Proton pump inhibitors remain the preferred
pharmaceutical option to treat
GERD. The ideal target of
GERD treatment is to restore esophageal motility and reconstruct the anti-reflux mechanism. This
review focuses on current advances in esophageal motor dysfunction in
patients with
GERD and the influence of these developments on
GERD treatment.