[Gastroesophageal reflux disease: therapeutic features (Part II)]. / La malattia da reflusso gastro-esofageo: aspetti terapeutici (Parte II).

Gastroesophageal reflux disease (GERD) can be defined as a condition resulting from the reflux of stomach contents into the esophagus. Its pharmacological treatment is aimed at symptom relief, healing of erosions and ulcerations and prevention of relapses. Based on the pathophysiology, the ideal treatment is directed to enhance basal sphincter pressure or decrease the frequency of TLESR, restore esophageal "clearance", accelerate gastric emptying and highten mucosal resistance as well as reduce or inhibit gastric acid secretion. Most of these targets are currently achievable because the availability of different types of drugs, however the "ideal" pharmacologic treatment of GERD does not exist. Current remedies for GERD include life style changes along with a wide array of antisecretory drugs, such as antacids, H2-antagonists and proton pump inhibitors (PPI). Surgery, based on anti-reflux procedures, and endoscopic approaches may have a role in the management of patients with GERD.

[Gastroesophageal reflux disease: clinical and pathophysiological features (part I)]. / La malattia da reflusso gastro-esofageo: aspetti clinici e fisio- patologici (Parte I).

Gastroesophageal reflux disease (GERD) can be described as a clinical picture resulting from the reflux of stomach contents into the esophagus. The actual prevalence of GERD remains unestablished, although this disorder is generally common in old patients, male sex and in subsets of patients with pulmonary manifestations such as asthma. From a pathophysiological stand-point, GERD is thought to have a multifactorial etiology which involves genetics, anatomical, functional, environmental, hormonal and pharmacological factors. GERD has different clinical presentations which may be divided in three main classes: typical symptoms (heartburn and regurgitation); atypical or extraesophageal symptoms (angina-like chest pain, asthma, chronic cough and laryngitis); and complications (ulcers, strictures and Barrett's esophagus). In GERD diagnosis a key role is played by: accurate symptom evaluation, response to proton pump inhibitors and, finally, at least one in a life-time endoscopy. Moreover, barium swallow X-ray, 24-h esophageal pH monitoring and gastro-esophageal manometry can be useful to support diagnosis in some unusual cases or in cases partially or unresponsive to standard pharmacologic treatment.