From 1906 to 2006 -- A Century of Major Evolution of Understanding of Gastro-oesophageal Reflux



Aliment Pharmacol Ther. 2006;24(9):1269-1281. 

In This Article

Summary and Introduction


Background: Our understanding of gastro-oesophageal reflux disease has undergone significant changes over the last century.
Aim: To trace the rise in understanding of gastro-oesophageal reflux disease and highlight remaining areas of uncertainty.
Methods: Literature review.
Results: In 1906, Tileston published his observations on 'peptic ulcer of the oesophagus'. Winkelstein, in 1934, first correlated symptoms of heartburn with acid regurgitation and reflux oesophagitis. In 1946, Allison described hiatus hernia as a causal factor in the development of gastro-oesophageal reflux disease. In 1958, Bernstein and Baker showed a direct relationship between oesophageal acidification and heartburn in patients with gastro-oesophageal reflux disease, irrespective of endoscopic findings, leading to the recognition of non-erosive gastro-oesophageal reflux disease. In the 1980s, continuous recordings of the lower oesophageal sphincter showed that episodes of reflux were related to transient relaxations of lower oesophageal sphincter tone. There is now increasing recognition that gastro-oesophageal reflux disease arises from the interaction of several anatomical and physiological factors. A turning point in the medical treatment of gastro-oesophageal reflux disease came with the introduction of the first proton pump inhibitor, omeprazole, in 1989.
Conclusions: Future efforts need to identify the multifactorial interactions of gastro-oesophageal junction anatomy and physiology in patients with gastro-oesophageal reflux disease. Increased understanding of the disease will guide development of new therapies.


There has been a major development of insight into gastro-oesophageal reflux disease (GERD; referred to subsequently as 'reflux disease') over the past 100 years; during this time, reflux disease has gone from being diagnosed very rarely during life to being the most frequently diagnosed disease of the upper gut in most Westernized countries. It is possible that the prevalence of reflux disease has increased somewhat in the past 100 years, but this cannot explain the huge increase in the rate of diagnosis that has occurred over this time. This increase is mostly attributable to improved insights into symptom patterns and the development of diagnostic methods. Together, these have enabled much better separation of reflux disease patients from those with upper gastrointestinal symptoms due to other causes. The rise in awareness of reflux disease has been accompanied by a corresponding increase in the number of publications on the disease (Figure 1). This review traces the rise in understanding of reflux disease over the past century, and aims thereby to highlight remaining areas of confusion.

Figure 1.

The increase in understanding of gastro-oesophageal reflux disease has been paralleled by an increase in the number of publications on the disease (data obtained from full PubMed searches by year, standardized to the total number of entries for that year).


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