New trends in gastroesophageal reflux disease treatment

Gastroesophageal reflux disease (GERD) remains a diagnostic and therapeutic challenge due to its heterogeneous presentation. Recent innovations aim to improve disease identification and management. Artificial intelligence applied to clinical questionnaires and endoscopy has achieved diagnostic accuracies above 90% for reflux-related lesions, Barrett’s esophagus, and squamous cell carcinoma, with performance comparable to expert endoscopists. Direct mucosal impedance allows real-time assessment of epithelial integrity, distinguishing GERD from eosinophilic esophagitis. Nocturnal reflux monitoring has advanced with multichannel intraluminal impedance-pH, mean nocturnal baseline impedance, the Bravo® wireless capsule, and wearable devices, enabling a more comprehensive evaluation. In parallel, emerging biomarkers including salivary pepsin, oral microbiome profiling, microRNA, and baseline impedance have shown potential as predictors of treatment response and progression to Barrett’s esophagus or adenocarcinoma. The introduction of standardized diagnostic frameworks, such as the Lyon Score and Milan Score, has further improved GERD phenotyping and functional stratification. Probiotics are also being explored as adjunctive therapies, with reported benefits in reflux and dyspeptic symptoms. Overall, these advances support a more precise and personalized approach to GERD diagnosis and management, although clinical validation and standardization are required before routine implementation.