Aims & Scopes of GERD Diagnosis

Before comparing the current and the novel concept we have to define the general and specific aims of GERD diagnosis.

General aims include:

  1. assess presence or absence of GERD
  2. identify those at risk for esophageal cancer development

Specific aims of GERD diagnosis include:

  1. identify those having GERD (i.e. exclude those not having GERD).
  2. identify those at risk for development of esophageal adenocarcinoma
  3. identify those suitable for medical or surgical treatment
  4. define length of Barrett's esophagus for ablation therapy.

Diagnosis in GERD aims to exclude:

  1. presence of esophageal adenocarcinoma
  2. presence of dysplasia
  3. presence of functional disorder (achalasia, distal esophageal spasm)

Currently a mixture of symptoms, endoscopy, histopathology and esophageal function test (manometry, pH-, impedance monitoring) defines gastroesophageal reflux disease (GERD).

This mix makes diagnosis and management of GERD very complicated and is reflected by an enormous linguistic babylonian confusion (GERD, NERD, ERD, functional heartburn) (Dent et al. Gut 1999; 44: S1-S16; Vakil et al. Am J Gastroenterol 2006; 101: 1900-1920).

With the current concept, premalignant lesions and early stage GERD are frequently missed (up to 60% of GERD patients) (Long et al. Minerva Gastroenterol Dietol 2007; 53: 127-141).These are the patients with reflux limited to the dilated end stage esophagus of the novel concept (see there).