The diagnosis of GE reflux based on symptoms alone is correct in only approximately two thirds of patients because the symptoms are often nonspecific and can be caused by other conditions.
The three characteristics of the LES that maintains its resistance or barrier function to intragastric and intraabdominal pressure challenges are pressure, overall length, and length exposed to the positive pressure environment of the abdomen.
An important complication of GE reflux is the development of reflux-induced respiratory symptoms either with or without heartburn.
Antireflux surgery improves respiratory symptoms in nearly 90% of children and 70% of adults with asthma and reflux disease.
Factors predisposing to the development of Barrett's esophagus include early-onset GERD, abnormal lower esophageal and esophageal body physiology, and mixed reflux of gastric and duodenal contents into the esophagus.
PPI therapy, both to relieve symptoms and to control esophagitis, is an acceptable treatment, although most patients will require life-long treatment.
Progression of nondysplastic Barrett's epithelium occurs with 5% to 10% of patients per year progressing to dysplasia and 0.5% to 1% per year progressing to cancer
The standard of care of the treatment of confirmed Barrett's esophagus with high-grade dysplasia is esophagectomy because approximately 50% will harbor invasive cancer
Three factors predictive of a successful outcome following antireflux surgery are (a) an abnormal score on 24-hour esophageal pH monitoring; (b) the presence of typical symptoms of GERD, namely heartburn or regurgitation; and (c) symptomatic improvement in response to acid-suppression therapy prior to surgery.