Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common condition that can be difficult to diagnose in individual patients in the absence of a diagnostic gold standard. In clinical practice, it is often possible to initially dispense with the diagnostic workup and treat patients on a trial basis. In patients for whom conservative treatment of reflux symptoms is not effective or for whom endoscopic or surgical intervention is planned, further functional diagnostics are required in addition to endoscopy with histology of the esophageal mucosa. This includes impedance pH measurement over 24 h (gold standard for reflux measurement) and usually also high-resolution manometry. An alternative to impedance pH measurement is continuous pH measurement using a sensor that is fixed endoscopically in the esophagus and can measure acid reflux over 96 h. A particular diagnostic challenge is the clarification of reflux symptoms that are refractory to proton pump inhibitors (PPI). This requires a staged approach with exclusion of other diseases, optimization of acid-inhibiting therapy as well as endoscopic, histological, and functional diagnostics. The results then allow for a rational treatment strategy. There is no diagnostic gold standard for the diagnosis of extra-esophageal complaints (e.g., globus sensation, cough). Pharyngeal pH measurements alone are inadequate and often lead to diagnostic and therapeutic errors.