Gastro-oesophageal reflux disease: a review of clinical features, investigations and recent trends in management.

ABSTRACT

BACKGROUND: Gastro-oesophageal reflux disease, though a common digestive disorder worldwide, is scarcely reported with very sparse literature in oursetting. AIM: To review the clinical features, investigations and recent developments in the management of gastro-oesophageal reflux disease. METHODS: We retrieved publications from local and international journals. We also searched Medline particularly for local references. Other sources of our data include Up-to-date in Medicine and standard texts in medicine and pathology. RESULTS: Local literature is generally lacking; while the classical symptoms of gastro-oesophageal reflux disease are heartburn, dysphagia and acid regurgitation, clinical examination is usually silent except when there are complications. There is no gold standard investigation but oesophageal pH monitoring, Bernstein test, oesophagoscopy and oesophageal manometry have been established to be useful in the evaluation of affected patients. Radiologic investigations, though insensitive in the diagnosis, are invaluable in diagnosing complications. Response to 14-day treatment with omeprazole (20 mg daily) has now been established to have a high sensitivity and specificity in diagnosing the condition. Management strategies include lifestyle modification, medical and surgical therapies. Proton pump inhibitors are now recognized as first line therapy in management. CONCLUSION: The prevalence and behaviour of this condition in Nigeria is not known and local references are scanty. This review article focused on the worldwide epidemiology, pathogenesis and recent trends in management to stimulate our interest in this area.