Gastroesophageal reflux disease revisited

For decades, gastroesophageal reflux disease (GERD) has been approached as a spectrum of disease. On one end of the spectrum are the patients with classic symptoms of GERD and normal esophageal mucosa. The other end of the spectrum is occupied by patients with GERD complications such as stricture, Barrett's esophagus, and adenocarcinoma of the esophagus. Removing the spectrum concept and approaching the GERD population as three unique groups of patients (nonerosive reflux disease, erosive esophagitis, and Barrett's esophagus) will dramatically shift our focus from esophageal mucosal injury to mechanisms leading to symptom generation in each group and foster specific therapeutic modalities that benefit each individual group of patients. The new paradigm suggests that each of the unique groups of GERD should be evaluated individually for the underlying mechanisms, therapeutic approaches, and potential complications. This process will enable us to better characterize each group and thus help to develop better strategies for diagnosis and treatment.