New concepts and methods in the study and treatment of gastroesophageal reflux disease.

This paper reviews progress in the use of 24-hour distal esophageal pH monitoring in the study of gastroesophageal reflux. This technique records acid exposure as numbers of reflux episodes and time required by the esophagus to return this acid juice to the stomach. These data afford an opportunity to conceptualize the pathophysiology of gastroesophageal reflux disease in relation to physiologic activities such as alimentation, sleep, and postural change. This knowledge will enable the clinician to critically focus attention on important issues of patient management and therapy as they relate to the pathophysiology of this disease.