Skip to main content

Definitions of Gastroesophageal Reflux Disease (GERD)

  • Chapter
  • First Online:
Diagnosis and Treatment of Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux (GER) can be physiologic, but becomes pathologic (gastroesophageal reflux disease, GERD) in the presence of symptoms or mucosal injury. In this chapter, we describe different approaches to defining the spectrum of GERD—symptomatic, endoscopic, ambulatory reflux monitoring parameters (both acid and impedance), structural/anatomic, and using newer diagnostic modalities.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20; quiz 1943.

    Article  PubMed  Google Scholar 

  2. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Shaheen NJ, Hansen RA, Morgan DR, Gangarosa LM, Ringel Y, Thiny MT, et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol. 2006;101:2128–38.

    Article  PubMed  Google Scholar 

  4. Becher A, El-Serag H. Systematic review: the association between symptomatic response to proton pump inhibitors and health-related quality of life in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2011;34:618–27.

    Article  CAS  PubMed  Google Scholar 

  5. Becher A, Dent J. Systematic review: ageing and gastro-oesophageal reflux disease symptoms, oesophageal function and reflux oesophagitis. Aliment Pharmacol Ther. 2011;33:442–54.

    Article  CAS  PubMed  Google Scholar 

  6. Boeckxstaens GE. Review article: the pathophysiology of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007;26:149–60.

    Article  CAS  PubMed  Google Scholar 

  7. Castell DO, Murray JA, Tutuian R, Orlando RC, Arnold R. Review article: the pathophysiology of gastro-oesophageal reflux disease—oesophageal manifestations. Aliment Pharmacol Ther. 2004;20 Suppl 9:14–25.

    Article  PubMed  Google Scholar 

  8. Fass R. Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol. 2007;41:131–7.

    Article  PubMed  Google Scholar 

  9. Savarino E, Zentilin P, Savarino V. NERD: an umbrella term including heterogeneous subpopulations. Nat Rev Gastroenterol Hepatol. 2013;10:371–80.

    Article  CAS  PubMed  Google Scholar 

  10. Ronkainen J, Aro P, Storskrubb T, Lind T, Bolling-Sternevald E, Junghard O, et al. Gastro-oesophageal reflux symptoms and health-related quality of life in the adult general population–the Kalixanda study. Aliment Pharmacol Ther. 2006;23:1725–33.

    Article  CAS  PubMed  Google Scholar 

  11. Wiklund I, Carlsson J, Vakil N. Gastroesophageal reflux symptoms and well-being in a random sample of the general population of a Swedish community. Am J Gastroenterol. 2006;101:18–28.

    Article  PubMed  Google Scholar 

  12. Dent J, Armstrong D, Delaney B, Moayyedi P, Talley NJ, Vakil N. Symptom evaluation in reflux disease: workshop background, processes, terminology, recommendations, and discussion outputs. Gut. 2004;53 Suppl 4:iv1–24.

    Google Scholar 

  13. Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383–91, e1–5.

    Article  PubMed  Google Scholar 

  14. Kahrilas PJ, Shaheen NJ, Vaezi MF, American Gastroenterological Association Institute, Clinical Practice and Quality Management Committee. American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1392–413, e1–5.

    Article  PubMed  Google Scholar 

  15. Dickman R, Mattek N, Holub J, Peters D, Fass R. Prevalence of upper gastrointestinal tract findings in patients with noncardiac chest pain versus those with gastroesophageal reflux disease (GERD)-related symptoms: results from a national endoscopic database. Am J Gastroenterol. 2007;102:1173–9.

    Article  PubMed  Google Scholar 

  16. Voutilainen M, Sipponen P, Mecklin JP, Juhola M, Färkkilä M. Gastroesophageal reflux disease: prevalence, clinical, endoscopic and histopathological findings in 1,128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms. Digestion. 2000;61:6–13.

    Article  CAS  PubMed  Google Scholar 

  17. Klauser AG, Schindlbeck NE, Muller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet. 1990;335:205–8.

    Article  CAS  PubMed  Google Scholar 

  18. Eubanks TR, Omelanczuk P, Richards C, Pohl D, Pellegrini CA. Outcomes of laparoscopic antireflux procedures. Am J Surg. 2000;179:391–5.

    Google Scholar 

  19. Madanick RD. Extraesophageal presentations of GERD: where is the science? Gastroenterol Clin North Am. 2014;43:105–20.

    Article  PubMed  Google Scholar 

  20. Francis DO, Rymer JA, Slaughter JC, Choksi Y, Jiramongkolchai P, Ogbeide E, et al. High economic burden of caring for patients with suspected extraesophageal reflux. Am J Gastroenterol. 2013;108:905–11.

    Article  PubMed  Google Scholar 

  21. Fass R, Ofman JJ, Gralnek IM, Johnson C, Camargo E, Sampliner RE, et al. Clinical and economic assessment of the omeprazole test in patients with symptoms suggestive of gastroesophageal reflux disease. Arch Intern Med. 1999;159:2161–8.

    Article  CAS  PubMed  Google Scholar 

  22. Johnsson F, Weywadt L, Solhaug JH, Hernqvist H, Bengtsson L. One-week omeprazole treatment in the diagnosis of gastro-oesophageal reflux disease. Scand J Gastroenterol. 1998;33:15–20.

    Article  CAS  PubMed  Google Scholar 

  23. Fass R, Ofman JJ, Sampliner RE, Camargo L, Wendel C, Fennerty MB. The omeprazole test is as sensitive as 24-h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive oesophagitis. Aliment Pharmacol Ther. 2000;14:389–96.

    Article  CAS  PubMed  Google Scholar 

  24. Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med. 2004;140:518–27.

    Article  CAS  PubMed  Google Scholar 

  25. DeVault KR, Castell DO, American College of Gastroentrology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005;100:190–200.

    Article  PubMed  Google Scholar 

  26. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–28; quiz 329.

    Article  PubMed  Google Scholar 

  27. Cremonini F, Wise J, Moayyedi P, Talley NJ. Diagnostic and therapeutic use of proton pump inhibitors in non-cardiac chest pain: a metaanalysis. Am J Gastroenterol. 2005;100:1226–32.

    Article  CAS  PubMed  Google Scholar 

  28. Wang WH, Huang JQ, Zheng GF, Wong WM, Lam SK, Karlberg J, et al. Is proton pump inhibitor testing an effective approach to diagnose gastroesophageal reflux disease in patients with noncardiac chest pain? A meta-analysis. Arch Intern Med. 2005;165:1222–8.

    Article  CAS  PubMed  Google Scholar 

  29. Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev. 2011:CD004823.

    Google Scholar 

  30. Shaheen NJ, Crockett SD, Bright SD, Madanick RD, Buckmire R, Couch M, et al. Randomised clinical trial: high-dose acid suppression for chronic cough – a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2011;33:225–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111:85–92.

    Article  CAS  PubMed  Google Scholar 

  32. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Takashima T, Iwakiri R, Sakata Y, Yamaguchi D, Tsuruoka N, Akutagawa K, et al. Endoscopic reflux esophagitis and Helicobacter pylori infection in young healthy Japanese volunteers. Digestion. 2012;86:55–8.

    Article  PubMed  Google Scholar 

  34. Richter JE, Kahrilas PJ, Johanson J, Maton P, Breiter JR, Hwang C, et al. Efficacy and safety of esomeprazole compared with omeprazole in GERD patients with erosive esophagitis: a randomized controlled trial. Am J Gastroenterol. 2001;96:656–65.

    Article  CAS  PubMed  Google Scholar 

  35. Lauritsen K, Deviere J, Bigard MA, Bayerdörffer E, Mózsik G, Murray F, et al. Esomeprazole 20 mg and lansoprazole 15 mg in maintaining healed reflux oesophagitis: metropole study results. Aliment Pharmacol Ther. 2003;17 Suppl 1:24; discussion 25–7.

    Article  PubMed  Google Scholar 

  36. Gaddam S, Wani S, Ahmed H, Maddur P, Hall SB, Gupta N, et al. The impact of pre-endoscopy proton pump inhibitor use on the classification of non-erosive reflux disease and erosive oesophagitis. Aliment Pharmacol Ther. 2010;32:1266–74.

    Article  CAS  PubMed  Google Scholar 

  37. Ronkainen J, Aro P, Storskrubb T, Johansson SE, Lind T, Bolling-Sternevald E, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–31.

    Article  PubMed  Google Scholar 

  38. Vela MF. Diagnostic work-up of GERD. Gastrointest Endosc Clin N Am. 2014;24:655–66.

    Article  PubMed  Google Scholar 

  39. Brandt MG, Darling GE, Miller L. Symptoms, acid exposure and motility in patients with Barrett’s esophagus. Can J Surg. 2004;47:47–51.

    PubMed Central  PubMed  Google Scholar 

  40. Lagergren J, Bergstrom R, Lindgren A, Nyrén O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340:825–31.

    Article  CAS  PubMed  Google Scholar 

  41. Shaheen NJ, Crosby MA, Bozymski EM, Sandler RS. Is there publication bias in the reporting of cancer risk in Barrett’s esophagus? Gastroenterology. 2000;119:333–8.

    Article  CAS  PubMed  Google Scholar 

  42. Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology. 1996;110:1982–96.

    Article  CAS  PubMed  Google Scholar 

  43. Pandolfino JE, Vela MF. Esophageal-reflux monitoring. Gastrointest Endosc. 2009;69:917–30, e1.

    Article  PubMed  Google Scholar 

  44. Hershcovici T, Gasiorowska A, Fass R. Advancements in the analysis of esophageal pH monitoring in GERD. Nat Rev Gastroenterol Hepatol. 2011;8:101–7.

    Article  PubMed  Google Scholar 

  45. Demeester TR, Johnson LF, Joseph GJ, Toscano MS, Hall AW, Skinner DB. Patterns of gastroesophageal reflux in health and disease. Ann Surg. 1976;184:459–70.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol. 1986;8 Suppl 1:52–8.

    Article  PubMed  Google Scholar 

  47. Jamieson JR, Stein HJ, DeMeester TR, Bonavina L, Schwizer W, Hinder RA, et al. Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol. 1992;87:1102–11.

    CAS  PubMed  Google Scholar 

  48. Richter JE, Bradley LA, DeMeester TR, Wu WC. Normal 24-hr ambulatory esophageal pH values. Influence of study center, pH electrode, age, and gender. Dig Dis Sci. 1992;37:849–56.

    Article  CAS  PubMed  Google Scholar 

  49. Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004;99:1037–43.

    Article  PubMed  Google Scholar 

  50. Zerbib F, des Varannes SB, Roman S, Pouderoux P, Artigue F, Chaput U, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther. 2005;22:1011–21.

    Article  CAS  PubMed  Google Scholar 

  51. Han MS, Peters JH. Ambulatory esophageal pH monitoring. Gastrointest Endosc Clin N Am. 2014;24:581–94.

    Article  PubMed  Google Scholar 

  52. Charbel S, Khandwala F, Vaezi MF. The role of esophageal pH monitoring in symptomatic patients on PPI therapy. Am J Gastroenterol. 2005;100:283–9.

    Article  PubMed  Google Scholar 

  53. Kuo B, Castell DO. Optimal dosing of omeprazole 40 mg daily: effects on gastric and esophageal pH and serum gastrin in healthy controls. Am J Gastroenterol. 1996;91:1532–8.

    CAS  PubMed  Google Scholar 

  54. Hirano I, Richter JE, Practice Parameters Committee of the American College of Gastroenterology. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–85.

    Article  PubMed  Google Scholar 

  55. Pandolfino JE, Richter JE, Ours T, Guardino JM, Chapman J, Kahrilas PJ. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol. 2003;98:740–9.

    Article  PubMed  Google Scholar 

  56. Ayazi S, Lipham JC, Portale G, Peyre CG, Streets CG, Leers JM, et al. Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy. Clin Gastroenterol Hepatol. 2009;7:60–7.

    Article  PubMed  Google Scholar 

  57. Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53:1024–31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Patel A, Sayuk GS, Gyawali CP. Parameters on esophageal pH impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2014;13:884–91.

    Google Scholar 

  59. Zerbib F, Roman S, Bruley Des Varannes S, Gourcerol G, Coffin B, Ropert A, et al. Normal values of pharyngeal and esophageal 24-hour pH impedance in individuals on and off therapy and interobserver reproducibility. Clin Gastroenterol Hepatol. 2013;11:366–72.

    Article  PubMed  Google Scholar 

  60. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001;120:1599–606.

    Article  CAS  PubMed  Google Scholar 

  61. Moawad FJ, Betteridge JD, Boger JA, Cheng FK, Belle LS, Chen YJ, et al. Reflux episodes detected by impedance in patients on and off esomeprazole: a randomised double-blinded placebo-controlled crossover study. Aliment Pharmacol Ther. 2013;37:1011–8.

    Article  CAS  PubMed  Google Scholar 

  62. Roman S, Poncet G, Serraj I, Zerbib F, Boulez J, Mion F. Characterization of reflux events after fundoplication using combined impedance-pH recording. Br J Surg. 2007;94:48–52.

    Article  CAS  PubMed  Google Scholar 

  63. Patel A, Sayuk GS, Gyawali CP. Acid-based parameters on pH-impedance testing predict symptom improvement with medical management better than impedance parameters. Am J Gastroenterol. 2014;109:836–44.

    Google Scholar 

  64. Wiener GJ, Richter JE, Copper JB, Wu WC, Castell DO. The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring. Am J Gastroenterol. 1988;83:358–61.

    CAS  PubMed  Google Scholar 

  65. Singh S, Richter JE, Bradley LA, Haile JM. The symptom index. Differential usefulness in suspected acid-related complaints of heartburn and chest pain. Dig Dis Sci. 1993;38:1402–8.

    Article  CAS  PubMed  Google Scholar 

  66. Weusten BL, Roelofs JM, Akkermans LM, Van Berge-Henegouwen GP, Smout AJ. The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology. 1994;107:1741–5.

    CAS  PubMed  Google Scholar 

  67. Ghillebert G, Janssens J, Vantrappen G, Nevens F, Piessens J. Ambulatory 24 hour intraoesophageal pH and pressure recordings v provocation tests in the diagnosis of chest pain of oesophageal origin. Gut. 1990;31:738–44.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  68. Kushnir VM, Sathyamurthy A, Drapekin J, Gaddam S, Sayuk GS, Gyawali CP. Assessment of concordance of symptom reflux association tests in ambulatory pH monitoring. Aliment Pharmacol Ther. 2012;35:1080–7.

    Google Scholar 

  69. Bredenoord AJ, Weusten BL, Timmer R, Conchillo JM, Smout AJ. Addition of esophageal impedance monitoring to pH monitoring increases the yield of symptom association analysis in patients off PPI therapy. Am J Gastroenterol. 2006;101:453–9.

    Article  PubMed  Google Scholar 

  70. Slaughter JC, Goutte M, Rymer JA, Oranu AC, Schneider JA, Garrett CG, et al. Caution about overinterpretation of symptom indexes in reflux monitoring for refractory gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2011 Oct;9(10):868–74

    Article  PubMed  Google Scholar 

  71. Kushnir VM, Sayuk GS, Gyawali CP. Abnormal GERD parameters on ambulatory pH monitoring predict therapeutic success in noncardiac chest pain. Am J Gastroenterol. 2010;105:1032–8.

    Article  PubMed  Google Scholar 

  72. Hersh MJ, Sayuk GS, Gyawali CP. Long-term therapeutic outcome of patients undergoing ambulatory pH monitoring for chronic unexplained cough. J Clin Gastroenterol. 2010;44:254–60.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Savarino E, Marabotto E, Zentilin P, Frazzoni M, Sammito G, Bonfanti D, et al. The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease. Dig Liver Dis. 2011;43:542–7.

    Article  PubMed  Google Scholar 

  74. Kavitt RT, Higginbotham T, Slaughter JC, Patel D, Yuksel ES, Lominadze Z, et al. Symptom reports are not reliable during ambulatory reflux monitoring. Am J Gastroenterol. 2012;107:1826–32.

    Article  PubMed  Google Scholar 

  75. Sellar RJ, De Caestecker JS, Heading RC. Barium radiology: a sensitive test for gastro-oesophageal reflux. Clin Radiol. 1987;38:303–7.

    Article  CAS  PubMed  Google Scholar 

  76. Ott DJ. Gastroesophageal reflux: what is the role of barium studies? AJR Am J Roentgenol. 1994;162:627–9.

    Article  CAS  PubMed  Google Scholar 

  77. Thompson JK, Koehler RE, Richter JE. Detection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring. AJR Am J Roentgenol. 1994;162:621–6.

    Article  CAS  PubMed  Google Scholar 

  78. Johnston BT, Troshinsky MB, Castell JA, Castell DO. Comparison of barium radiology with esophageal pH monitoring in the diagnosis of gastroesophageal reflux disease. Am J Gastroenterol. 1996;91:1181–5.

    CAS  PubMed  Google Scholar 

  79. Lacy BE, Weiser K, Chertoff J, Fass R, Pandolfino JE, Richter JE, et al. The diagnosis of gastroesophageal reflux disease. Am J Med. 2010;123:583–92.

    Article  PubMed  Google Scholar 

  80. Ott DJ, Glauser SJ, Ledbetter MS, Chen MY, Koufman JA, Gelfand DW. Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus. AJR Am J Roentgenol. 1995;165:557–9.

    Article  CAS  PubMed  Google Scholar 

  81. Dickman R, Boaz M, Aizic S, Beniashvili Z, Fass R, Niv Y. Comparison of clinical characteristics of patients with gastroesophageal reflux disease who failed proton pump inhibitor therapy versus those who fully responded. J Neurogastroenterol Motil. 2011;17:387–94.

    Article  PubMed Central  PubMed  Google Scholar 

  82. Sloan S, Kahrilas PJ. Impairment of esophageal emptying with hiatal hernia. Gastroenterology. 1991;100:596–605.

    CAS  PubMed  Google Scholar 

  83. Kasapidis P, Vassilakis JS, Tzovaras G, Chrysos E, Xynos E. Effect of hiatal hernia on esophageal manometry and pH-metry in gastroesophageal reflux disease. Dig Dis Sci. 1995;40:2724–30.

    Article  CAS  PubMed  Google Scholar 

  84. Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way LW. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg. 1996;171:182–6.

    Article  CAS  PubMed  Google Scholar 

  85. Weijenborg PW, van Hoeij FB, Smout AJ, Bredenoord AJ. Accuracy of hiatal hernia detection with esophageal high-resolution manometry. Neurogastroenterol Motil. 2015;27:293–9.

    Article  CAS  PubMed  Google Scholar 

  86. Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. Br Med J. 2014;349:g6154.

    Article  Google Scholar 

  87. Fletcher J, Wirz A, Young J, Vallance R, McColl KE. Unbuffered highly acidic gastric juice exists at the gastroesophageal junction after a meal. Gastroenterology. 2001;121:775–83.

    Article  CAS  PubMed  Google Scholar 

  88. Kahrilas PJ, McColl K, Fox M, O’Rourke L, Sifrim D, Smout AJ, et al. The acid pocket: a target for treatment in reflux disease? Am J Gastroenterol. 2013;108:1058–64.

    Article  CAS  PubMed  Google Scholar 

  89. Beaumont H, Bennink RJ, de Jong J, Boeckxstaens GE. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut. 2010;59:441–51.

    Article  PubMed  Google Scholar 

  90. Nandurkar S, Talley NJ, Martin CJ, Wyatt JM. Esophageal histology does not provide additional useful information over clinical assessment in identifying reflux patients presenting for esophagogastroduodenoscopy. Dig Dis Sci. 2000;45:217–24.

    Article  CAS  PubMed  Google Scholar 

  91. Calabrese C, Bortolotti M, Fabbri A, Areni A, Cenacchi G, Scialpi C, et al. Reversibility of GERD ultrastructural alterations and relief of symptoms after omeprazole treatment. Am J Gastroenterol. 2005;100:537–42.

    Article  CAS  PubMed  Google Scholar 

  92. Boeckxstaens GE, Rohof WO. Pathophysiology of gastroesophageal reflux disease. Gastroenterol Clin North Am. 2014;43:15–25.

    Article  PubMed  Google Scholar 

  93. van Malenstein H, Farre R, Sifrim D. Esophageal dilated intercellular spaces (DIS) and nonerosive reflux disease. Am J Gastroenterol. 2008;103:1021–8.

    Article  PubMed  Google Scholar 

  94. Kessing BF, Bredenoord AJ, Weijenborg PW, Hemmink GJ, Loots CM, Smout AJ. Esophageal acid exposure decreases intraluminal baseline impedance levels. Am J Gastroenterol. 2011;106:2093–7.

    Article  CAS  PubMed  Google Scholar 

  95. Kandulski A, Weigt J, Caro C, Jechorek D, Wex T, Malfertheiner P. Esophageal intraluminal baseline impedance differentiates gastroesophageal reflux disease from functional heartburn. Clin Gastroenterol Hepatol. 2015;13:1075–81.

    Google Scholar 

  96. Weijenborg PW, Cremonini F, Smout AJ, Bredenoord AJ. PPI therapy is equally effective in well-defined non-erosive reflux disease and in reflux esophagitis: a meta-analysis. Neurogastroenterol Motil. 2012;24:747–57, e350.

    Article  CAS  PubMed  Google Scholar 

  97. Boeckxstaens G, El-Serag HB, Smout AJ, Kahrilas PJ. Symptomatic reflux disease: the present, the past and the future. Gut. 2014;63:1185–93.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Patel, A., Gyawali, C. (2016). Definitions of Gastroesophageal Reflux Disease (GERD). In: Vaezi, M. (eds) Diagnosis and Treatment of Gastroesophageal Reflux Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-19524-7_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19524-7_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19523-0

  • Online ISBN: 978-3-319-19524-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics