Recent Advances in the Diagnosis and Treatment of Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux disease (GERD) is a common, chronic condition that significantly affects patient quality of life and may lead to complications such as erosive esophagitis, Barrett’s esophagus, and peptic strictures. In recent years, diagnostic approaches to GERD have evolved, with the updated Lyon Consensus 2.0 and the 2020 Seoul Consensus providing more structured, evidence-based criteria. These include not only conventional endoscopic and pH-monitoring findings but also impedance-based parameters such as the mean nocturnal baseline impedance (MNBI) and the post-reflux swallow-induced peristaltic wave (PSPW) index, which enhance diagnostic accuracy and allow better phenotyping of GERD. In terms of treatment, lifestyle modification remains the cornerstone of GERD management and is essential for reducing long-term dependence on pharmacologic therapy. Proton pump inhibitors (PPIs) are the mainstay of pharmacologic treatment, and their effectiveness can be improved through modified-release or immediate-release buffered formulations. Recently, potassium-competitive acid blockers (P-CABs) such as tegoprazan, fexuprazan, and zastaprazan have emerged as effective alternatives to PPIs, offering advantages such as rapid onset of action, prolonged acid suppression, and more predictable pharmacokinetics, particularly in East Asian populations. However, concerns remain regarding long-term safety, including the risk of hypergastrinemia. This review summarizes recent advances in GERD diagnosis and treatment, highlighting the importance of individualized management strategies that incorporate updated diagnostic criteria and the evolving pharmacologic landscape.