Developments in Gastroesophageal Reflux Disease over the Last 40 Years

<b><i>Background:</i></b> The last 40 years have seen a remarkable change in our understanding of reflux disease. <b><i>Summary:</i></b> These changes encompass disease definition and impact, pathophysiology, diagnostic testing, regulatory oversight of clinical trials, pharmacotherapy, endoscopic, and surgical treatment. We have also seen a number of promising therapies fail. <b><i>Key Messages:</i></b> The future holds the promise of further advances. Adaptive artificial intelligence will take over diagnostics in manometry and pH impedance testing and patient-driven outcomes may be changed by interactions with artificial intelligence rather than humans. Changes in chip technology will allow higher resolution chips to be carried on smaller devices making extra-esophageal areas where reflux may play a role more accessible to prolonged observation and testing.