Gastroesophageal reflux disease, Barrett's esophagus. Pathophysiology, classification and treatment. Review

Introduction: The pathophysiology of Gastroesophageal Reflux Disease is reviewed as well as the classification of Barret's esophagus. Several therapeutic perspectives are addressed: the use of drugs, surgery, endoprosthesis and tissue regeneration therapies with stem cells. Objectives: To discuss the pathophysiology of GERD as well as the evolution of available treatments for this condition. To highlight the impact of stem cell therapy and the development of organoids for the reconstruction of esophageal regions such as the lower esophageal sphincter. Materials and methods:Pubmed and Google Scholar were searched using the keywords: gastroesophageal reflux disease, GERD, GERD physiopathology, digestive physiology, esophagus anatomy histology, Barrett's esophagus, Barrett's esophagus diagnosis, esophageal adenocarcinoma, GERD treatment, GERD surgery, GERD implants.Papers published from 2018 to 2022 inclusive were filtered by full text and sorted by "most recent". Reviews and original papers were included. Only those publicly available were consulted. Conclusion: GERD is a highly prevalent condition that is related to exposure to multiple environmental factors. Hydrogen retrodiffusion and variant gastric contents reaching the esophagus lead to metaplastic changes that may result in adenocarcinomas. Various diagnostic techniques such as VEDA, manometry, pHmetry, and impedancemetry also allow the monitoring and prognostic characterization of GERD. Nutritional prevention, lifestyle changes and pharmacological approach aim to favor the competence of the lower esophageal sphincter, as well as to decrease the production of hydrochloric acid and the overexposure of the esophageal mucosa. Surgery and translational medicine, such as stem cell tissue engineering, offer promising approaches for esophageal reconstruction, while the results obtained with organoids and 3D printing on biomatrices foreshadow the production of functional esophagi as part of new therapies for GERD.