Gastroesophageal reflux disease: comprehensive review from medical to surgical management

Abstract

BACKGROUND AIM: Gastroesophageal reflux disease (GERD) affects 6-20% of the population globally, with lower prevalence in Asia and higher rates in Western countries. The disorder, diagnosed across multiple specialties, manifests through a spectrum of symptoms-ranging from classic heartburn and regurgitation to atypical and extra-esophageal presentations. Management often becomes fragmented as patients consult various providers. This review aims to comprehensively evaluate gastroesophageal reflux disease management, from lifestyle modifications and pharmacotherapy to diagnostic pathways and surgical interventions. METHODS: This review performed a narrative review of current definitions, pathophysiology, symptomatology, diagnostic strategies, and therapeutic options. Sources include major practice guidelines (American, Japanese, British), clinical trials, and emerging technologies spanning medical, endoscopic, and surgical modalities. RESULTS: gastroesophageal reflux disease diagnostics start with symptom-based clinical evaluation. Empirical therapy includes lifestyle changes such as weight loss, dietary modifications, head-of-bed elevation, and timing of meals. A standard 8-week course of proton pump inhibitors is more effective than H₂-receptor antagonists; high-potency proton pump inhibitors or twice-daily dosing may be warranted in refractory cases. Potassium-competitive acid blockers (e.g., vonoprazan) offer alternative acid suppression. Diagnostic testing-upper endoscopy, impedance‑pH monitoring, barium studies, and manometry-is indicated in treatment failures, alarm features, or when considering surgical/endoscopic intervention. Surgically, laparoscopic or robotic fundoplication remains the gold standard for patients with inadequate response to medical therapy or long-term proton pump inhibitor use. Magnetic sphincter augmentation presents as a minimally invasive alternative. Endoscopic therapies (e.g., Stretta, transoral incisionless fundoplication 2.0) show promise, yet lack long-term data and are typically reserved for select patients. CONCLUSION: gastroesophageal reflux disease is a heterogeneous, multifaceted disease requiring a tailored approach. Initial management prioritizes lifestyle measures and empiric acid suppression. Diagnostic evaluation refines treatment in non-responders or complicated cases. Effective long-term control may require surgery or endoscopic intervention, particularly for patients with refractory symptoms, hiatal hernia, or concerns over chronic proton pump inhibitor use. Further research is needed to establish long-term efficacy and optimal patient selection for advanced therapies.