Modern views on the various phenotypes of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common gastroenterological diseases. For a long time, GERD was considered as a continuum of various pathological conditions based on the degree of dysfunction of the lower esophageal sphincter, from non‑erosive GERD (NERD) and reflux esophagitis to Barrett’s esophagus and esophageal adenocarcinoma. Currently, the views on the GERD pathophysiology have significantly changed. To date, it is believed that various presentations of GERD represent its individual phenotypes with unique predisposing cofactors and pathophysiology outside this paradigm. Different GERD phenotypes include NERD, reflux esophageal hypersensitivity, functional heartburn, low and high degree reflux esophagitis, Barrett’s esophagus, regurgitation‑dominant GERD, extra‑esophageal GERD, and reflux chest pain syndrome. Due to the fact that not all GERD phenotypes are the same, clinical management of GERD patients should be carried out differentially, depending on the unique pathophysiological features of each phenotype. The time has come to apply a personalized approach to the management of patients with various GERD phenotypes, which will undoubtedly improve the results of treatment of this heterogeneous and extremely widespread pathology in the future.