Current concepts in the diagnosis and treatment of gastro-oesophageal reflux disease

OBJECTIVE. To summarise the current scientific evidence regarding up-to-date approaches to the diagnosis, phenotyping and treatment of gastro-oesophageal reflux disease, taking into account modern principles of personalised medicine. MATERIALS AND METHODS. A narrative review was conducted of the current scientific literature and international clinical guidelines on the diagnosis and treatment of GERD. The literature search was conducted in the PubMed/MEDLINE, Scopus, Web of Science Core Collection and Google Scholar databases. The analysis included clinical guidelines, consensus documents, systematic reviews, meta-analyses and original studies, using comparative, analytical and summarising approaches. RESULTS. Current concepts in the diagnosis of GERD were analysed, in particular the role of endoscopic and functional investigative methods (ambulatory pH monitoring, pH-impedance monitoring, manometry) in confirming pathological reflux and determining the mechanisms underlying symptom development. Particular attention is paid to the current phenotyping of the disease, distinguishing between erosive reflux disease, non-erosive reflux disease, reflux hypersensitivity and functional heartburn. Current approaches to the treatment of GERD are described, including lifestyle modification, optimisation of proton pump inhibitor therapy, the use of potassium-competitive acid secretion blockers, alginates and interventional treatment methods. The need for an individualised choice of therapeutic strategy, depending on the disease phenotype, the mechanism underlying symptom onset and the presence of complications, is highlighted. CONCLUSIONS. The current management of patients with gastro-oesophageal reflux disease is based on a shift from a symptom-oriented model to a personalised, phenotype-oriented approach. Objective verification of pathological reflux and identification of the mechanisms underlying symptom development are key to selecting effective treatment, improving disease control and enhancing patients’ quality of life.