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New insights into the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a chronic relapsing disorder commonly encountered in the primary care setting. Considerable uncertainty still exists with respect to basic questions concerning pathophysiological factors and the cause of extraoesophageal symptoms in some patients with GERD. The numerous receptors located in the muscular layer at the site of the lower oesophageal sphincter (LES) are under neurological control. These receptors are of interest in the investigation of both LES dysfunction and new potential pharmacological approaches for GERD. Therapies for GERD, based on various pathophysiological mechanisms, with attention to either drug inhibition of acid secretion, protection of the oesophageal mucosa, influencing salivary composition or improving oesophageal clearance, have been reviewed. Alternative approaches to the more traditional treatments for gastroesophageal reflux disease are also being pursued. In particular, pharmacological efforts towards modification of intrinsic and extrinsic neurological controls of oesophageal motility, aimed at improving LES function, are discussed.