Western Treatment of Reflux Disease

Abstract

Gastroesophageal reflux disease is a common condition in the Western world, affecting approximately 20% of patients on a weekly basis. Multiple mechanisms have been hypothesized as potential culprits, including abnormal acid production, impaired esophagogastric junction dynamics, hiatal hernia, impaired esophageal motility or clearance, decreased salivary buffering, esophageal hypersensitivity, impaired gastric emptying, and alterations in the microbiome. Therapy has been targeted to the hypothesized mechanisms but most often has focused on the suppression of gastric acid production and strengthening of the esophagogastric junction. This chapter will briefly highlight the key therapeutic options for reflux in Western medicine, including diet and lifestyle modification, acid suppressive therapy (antacids, histamine-receptor antagonists, proton pump inhibitors), other medical options (alginates, sucralfate, gabapentin, prokinetics), endoscopic options (radiofrequency ablation, transoral incisionless fundoplication), and surgical options (fundoplication, magnetic sphincter augmentation, gastric bypass).