Gastroesophageal reflux disease (GERD) is a highly prevalent chronic disorder, affecting around 20% of adults in North America. Management of this condition has steadily evolved thanks to expanding diagnostic tools, new therapies, and advances in procedural techniques.
Below are five hot topics for assessment and treatment of GERD:
Disease assessment
GERD is a spectrum, ranging from non-erosive reflux disease to erosive esophagitis. Accurate phenotyping (clinical history, endoscopy, and ambulatory reflux testing when needed) can help guide therapy and treatment options. If patients do not respond to a trial of proton pump inhibitors (PPIs), the next diagnostic step is to perform an upper endoscopy to determine if structural changes are present. Other disorders can also mimic GERD symptoms, such as eosinophilic esophagitis or esophageal spasm. Some consequences of GERD, such as Barrett’s esophagus, are clinically silent.
New available therapies
While PPIs have long been the mainstay of treatment for GERD, potassium-competitive acid blockers (PCABs, such as vonoprazan) are emerging as a faster and more potent alternative for acid suppression. Advantages of these medications include greater efficacy than PPIs and improved ease of use, without the requirement to be timed prior to meals, but the cost of prescriptions currently limits widespread use.
Laryngopharyngeal symptoms (LPS)
LPS are aerodigestive symptoms that are potentially induced by reflux, including cough, throat clearing, excess phlegm, and voice changes. The evaluation of LPS may include laryngoscopy, upper endoscopy, and/or ambulatory reflux monitoring depending on a patient’s symptoms. Treatment is guided by the presence of evidence of reflux, and ranges from anti-reflux therapy to speech language pathology-guided behavioral therapy and neuromodulation.
Obesity, GLP-1s, and GERD
Obesity raises intra-abdominal pressure, promotes hiatal hernia formation, and weakens the lower esophageal sphincter, all of which increases the risk of GERD. New treatments for obesity, such as GLP-1 agonists, can result in weight loss and improvement of GERD-related symptoms. However, some patients may experience an increase in their acid reflux symptoms while taking these medications due to the presence of slowed gastric emptying, which can contribute to reflux.
Advances in procedural management
Numerous advances have been made in the past several years in procedures to treat GERD. At The Oregon Clinic, we offer both surgical solutions, such as Nissen, Toupet, and LINX surgeries, as well as endoscopic approaches such as transoral incisionless fundoplication. Selecting the appropriate procedural approach for each patient is based on careful individual evaluation and collaborative engagement between our patients and providers.
References
- Katz P, et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.
- Seo S, et al. Treatment Response With Potassium-competitive Acid Blockers Based on Clinical Phenotypes of Gastroesophageal Reflux Disease: A Systematic Literature Review and Meta-analysis. J Neurogastroenterol Motil. 2024 Jul 30;30(3):259-271
- Yadlapati, R, et al. The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease. The American Journal of Gastroenterology 2026 Feb 121(2):p 322-336.
- Chang P, Friedenberg F. Obesity and GERD. Gastroenterol Clin North Am. 2014 Mar;43(1):161-73.