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Gastroesophageal Reflux Disease

GERD

Gastroesophageal reflux disease is a common condition caused by the reflux of gastric contents into the esophagus.


Presentation

Patients with gastroesophageal reflux disease usually present with heartburn and acid regurgitation into the esophagus [1]. A minority of patients present with supraesophageal symptoms such as dental erosions, laryngitis, asthma, cough, or non-cardiac chest pain [1].

Gastroesophageal reflux disease-related complications include erosive esophagitis, Barrett esophagus, and esophageal adenocarcinoma [2].

The typical symptoms of gastroesophageal reflux disease include [1] [2] [5]:

Atypical (supraesophageal) symptoms include the following [2] [4]:

Weight Gain
  • No edema of lower limbs or weight gain occurred. No adverse reactions related to the testing drug had been reported and all the authors concluded that alginate was safe for the unborn baby.[ncbi.nlm.nih.gov]
  • Blood and urine tests can help identify or rule out possible causes of recurring vomiting and poor weight gain. Esophageal pH monitoring.[mayoclinic.org]
  • Avoiding these items may reduce your discomfort: coffee citrus drinks tomato-based products carbonated beverages chocolate peppermint fatty or spicy foods eating within three hours of bedtime smoking excess alcohol consumption excess weight gain Propping[asge.org]
  • Gastric bypass : Acid reflux can result from significant weight gain and obesity. For some people, gastric bypass surgery is the best treatment choice.[stanfordhealthcare.org]
  • The vomiting that affects many babies and children with GERD can cause problems with weight gain and poor nutrition.[hopkinsmedicine.org]
Cerebral Palsy
  • palsy , Down syndrome , and other heritable syndromes associated with developmental delay, have an increased prevalence of gastroesophageal reflux Chronic LES laxity Reflux is facilitated when an increase in intraabdominal pressure occurs.[emedicine.medscape.com]
  • Kids with developmental or neurological conditions, such as cerebral palsy , are more at risk for GER and can have more severe, lasting symptoms. Symptoms of GER Heartburn is the most common symptom of GER in kids and teens.[kidshealth.org]
  • Your child is more at risk for GERD if he or she has: Down syndrome Neuromuscular disorders such as muscular dystrophy and cerebral palsy What are the symptoms of GERD? Heartburn, or acid indigestion, is the most common symptom of GERD.[hopkinsmedicine.org]
Down Syndrome
  • syndrome , and other heritable syndromes associated with developmental delay, have an increased prevalence of gastroesophageal reflux Chronic LES laxity Reflux is facilitated when an increase in intraabdominal pressure occurs.[emedicine.medscape.com]
  • Your child is more at risk for GERD if he or she has: Down syndrome Neuromuscular disorders such as muscular dystrophy and cerebral palsy What are the symptoms of GERD? Heartburn, or acid indigestion, is the most common symptom of GERD.[hopkinsmedicine.org]
Recurrent Otitis Media
  • Conversely, no conclusive clinical evidence supports a link between gastroesophageal reflux and other supraesophageal problems, including otalgia, recurrent otitis media, and chronic sinusitis.[emedicine.medscape.com]
Amyloidosis
  • A possible connection between GERD and sarcoidosis, amyloidosis, hypothyroidism, rheumatoid arthritis, mixed connective tissue disorders, Sjögren's syndrome, systemic sclerosis, diabetes mellitus, cholecystectomy, sleeve gastrectomy, sleep apnea syndrome[ncbi.nlm.nih.gov]
Cough
  • This case suggests cough as an adverse drug event to omeprazole, which is otherwise commonly prescribed for the management of GERD-related cough.[ncbi.nlm.nih.gov]
  • Abstract Gastroesophageal reflux disease (GERD) is recognized to be present in 10-20% of cases of chronic cough. Proving that it is the cause of the cough is more difficult.[ncbi.nlm.nih.gov]
  • The extraesophageal manifestations of gastroesophageal reflux disease (GERD) include chronic cough, laryngopharyngeal reflux, and asthma.[ncbi.nlm.nih.gov]
  • However, after repeated bouts of coughing, the heart rate showed bradycardia associated with convulsion. He was diagnosed with cough syncope secondary to laryngopharyngitis, which was caused by gastroesophageal reflux disease (GERD).[ncbi.nlm.nih.gov]
  • The most common symptoms were hoarseness (71%), cough (51%), globus (47%), and throat clearing (42%). Only 43% of the patients had gastrointestinal symptoms (heartburn or acid regurgitation).[ncbi.nlm.nih.gov]
Hoarseness
  • Abstract An increasing amount of evidence indicates that gastroesophageal reflux disease (GERD) is a contributing factor to hoarseness, throat clearing, throat discomfort, chronic cough, and shortness of breath.[ncbi.nlm.nih.gov]
  • RESULTS: A 36-year-old woman had dyspnea, hoarseness, chest pain, and wheezes without relief for a decade. Neuropsychiatric evaluations disclosed mild depression.[ncbi.nlm.nih.gov]
  • The most common symptoms were hoarseness (71%), cough (51%), globus (47%), and throat clearing (42%). Only 43% of the patients had gastrointestinal symptoms (heartburn or acid regurgitation).[ncbi.nlm.nih.gov]
  • Other symptoms may accompany this disease including non-cardiac chest pain, asthma, pneumonia, hoarseness, and aspiration.[symptoma.com]
  • Other symptoms of GERD include: Increase in saliva Chest pain Chronic dry coughing Nausea Bad breath Hoarseness Laryngitis When acid reflux enters the throat beyond the upper esophageal sphincter, it can cause a sore throat and lead to hoarseness.[manhattangastroenterology.com]
Sore Throat
  • Untreated, GERD can lead to chronic laryngitis, dysphonia, chronic sore throat, chronic cough, constant throat clearing, granuloma of the true vocal cords and other problems.[ncbi.nlm.nih.gov]
  • It is a chronic, progressive disorder that presents most typically with heartburn and regurgitation and atypically with chest pain, dysphagia, chronic cough, globus, or sore throat.[ncbi.nlm.nih.gov]
  • Other symptoms that occur less frequently but can indicate that you could have GERD are: • Acid regurgitation (retasting your food after eating) • Difficulty or pain when swallowing • Sudden excess of saliva • Chronic sore throat • Laryngitis or hoarseness[aaaai.org]
  • Heartburn sufferers may also experience a sore throat, hoarseness, chronic cough, asthma or a feeling of a lump in the throat. Because there can be chest pain associated with GERD, heartburn sometimes is mistaken for heart attack.[medstarmontgomery.org]
Dry Cough
  • Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing. Anyone, including infants and children , can have GERD. If not treated, it can lead to more serious health problems. In some cases, you might need medicines or surgery.[medlineplus.gov]
  • Common clinical features in adults include epigastric and retrosternal burning sensations (heartburn or pyrosis), regurgitation leaving an acidic taste in the mouth, waterbrash (increased salivation), enamel erosions, and a chronic dry cough 1 .[radiopaedia.org]
  • Other symptoms of GERD include: Increase in saliva Chest pain Chronic dry coughing Nausea Bad breath Hoarseness Laryngitis When acid reflux enters the throat beyond the upper esophageal sphincter, it can cause a sore throat and lead to hoarseness.[manhattangastroenterology.com]
  • Difficulty swallowing, dry cough, sensing a lump in the throat, hoarseness and regurgitating food or a sour taste may also indicate GERD. Obesity, pregnancy and asthma may cause or exacerbate GERD, as can smoking.[livescience.com]
Non-Cardiac Chest Pain
  • In addition to typical reflux symptoms, it can also be used for diagnostic purposes in patients with non-cardiac chest pain (NCCP).[ncbi.nlm.nih.gov]
  • Other symptoms may accompany this disease including non-cardiac chest pain, asthma, pneumonia, hoarseness, and aspiration.[symptoma.com]
  • The symptoms non-cardiac chest pain, dysphagia, globus, dyspepsia, cough, wheezing and hoarseness, have all been reported to be associated with GERD.[hon.ch]
  • See Table Top of page 31 Prevalence of Gastroesophageal Reflux Disease in Patients with Non-Cardiac Chest Pain Presenting to the Emergency Department Stephanie E. Thompson, MD, Julia J. Liu, MD, John R.[web.archive.org]
Vomiting
  • MSA is associated with less gas/bloat symptoms and increased ability to vomit and belch. Copyright 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Abstract We report an unusual presentation of gastroesophageal reflux disease in a 14-yr-old boy with cervical dysphagia and vomiting immediately after swallowing.[ncbi.nlm.nih.gov]
  • Some babies with reflux can’t gain weight because they vomit often.[hopkinsmedicine.org]
  • The only immediate adverse effects due to the LINX procedure were bloating, nausea, and vomiting.[ncbi.nlm.nih.gov]
  • Some consider the small reservoir capacity of the infant's esophagus to be a predisposing factor to vomiting. The causes and risk factors for gastroesophageal reflux in children are frequently multifactorial.[emedicine.medscape.com]
Nausea
  • Trials of citalopram and escitalopram were associated with reports of persistent nausea and gastric reflux unresolved by changes in dosing schedule or positioning. Over-the-counter omeprazole on an as-needed basis was added.[ncbi.nlm.nih.gov]
  • Data were collected retrospectively from medical records included age, gender, predisposing factors for ABPA, chronic pulmonary aspergillosis, or Aspergillus bronchitis; presence of nocturnal reflux, nausea, epigastric pain, Medical Research Council dyspnea[ncbi.nlm.nih.gov]
  • The only immediate adverse effects due to the LINX procedure were bloating, nausea, and vomiting.[ncbi.nlm.nih.gov]
  • Symptoms Heartburn A burning sensation in your chest Reflux Backing up of stomach acids that may taste sour or bitter Dyspepsia Stomach discomfort with nausea or bloating after eating Shortness of breath Feeling that you cannot get enough air Symptoms[ctsurgerypatients.org]
Hiccup
  • Hiccup ceased only after blockade of the right phrenic nerve with 4 ml/h l% ropivacaine and relapsed soon after discontinuation.[ncbi.nlm.nih.gov]
  • […] backing up into your throat or mouth Other symptoms of acid reflux disease include: Bloating Bloody or black stools or bloody vomiting Burping Dysphagia -- a narrowing of your esophagus, which creates the sensation of food being stuck in your throat Hiccups[evergreenhealth.com]
  • Check if you have acid reflux The main symptoms of acid reflux are: heartburn – a burning sensation in the middle of your chest an unpleasant sour taste in your mouth, caused by stomach acid You may also have: a cough or hiccups that keep coming back[nhs.uk]
  • […] babies and young children, GER can lead to problems during and after feeding, including: frequent regurgitation or vomiting, especially after meals choking or wheezing (if the contents of the reflux get into the windpipe and lungs) wet burps or wet hiccups[kidshealth.org]
  • Other potential signs and symptoms of GERD in infants includes: refusal to eat trouble swallowing gagging or choking wet burps or hiccups irritability during or after feeding arching of their back during or after feeding weight loss or poor growth recurring[healthline.com]
Pyrosis
  • Abstract The report presents a case of a 46-year-old male patient, previously treated because of dysphagia, pyrosis, vertigo while standing up and impotency.[ncbi.nlm.nih.gov]
  • Common clinical features in adults include epigastric and retrosternal burning sensations (heartburn or pyrosis), regurgitation leaving an acidic taste in the mouth, waterbrash (increased salivation), enamel erosions, and a chronic dry cough 1 .[radiopaedia.org]
  • A study by Richter and a Gallup Organization National Survey estimated that 25-40% of healthy adult Americans experience symptomatic GERD, most commonly manifested clinically by pyrosis (heartburn), at least once a month.[emedicine.com]
Gagging
  • Other potential signs and symptoms of GERD in infants includes: refusal to eat trouble swallowing gagging or choking wet burps or hiccups irritability during or after feeding arching of their back during or after feeding weight loss or poor growth recurring[healthline.com]
  • Choking, gagging, coughing with feedings or significant irritability can be warning signs for GERD or other diagnoses.[link.springer.com]
Chest Pain
  • All the symptoms except chest pain were improved dramatically by speech therapy and empirical treatment for GERD.[ncbi.nlm.nih.gov]
  • Abstract A significant percentage of patients with gastroesophageal reflux disease may experience extraesophageal manifestations, such as chest pain or asthma. These symptoms are more difficult to diagnose than the usual esophageal symptoms.[ncbi.nlm.nih.gov]
  • In addition to the cardinal symptoms of heartburn and regurgitation, people with GERD can also have sleep disturbances, chest pains, or respiratory symptoms.[ncbi.nlm.nih.gov]
  • In addition to typical reflux symptoms, it can also be used for diagnostic purposes in patients with non-cardiac chest pain (NCCP).[ncbi.nlm.nih.gov]
  • It is a chronic, progressive disorder that presents most typically with heartburn and regurgitation and atypically with chest pain, dysphagia, chronic cough, globus, or sore throat.[ncbi.nlm.nih.gov]
Tooth Erosion
  • Tooth erosion and wear are common oral manifestations of GERD.[ncbi.nlm.nih.gov]
  • Gastric reflux is a significant causative factor of tooth erosion. J Dent Res . 2009; 88 :422-426. [ PubMed ] [ DOI ] 22. Ward PH , Hanson DG. Reflux as an etiological factor of carcinoma of the laryngopharynx.[dx.doi.org]
Skin Lesion
  • First skin lesions accompanied by gastrointestinal symptoms (regurgitations, appetite worsening) were noticed at the age of four months. At that time, they were misdiagnosed as symptoms of cow's milk allergy.[ncbi.nlm.nih.gov]
Sleep Disturbance
  • Abstract A 2.5-year-old child presented with a sleep disturbance initially diagnosed as a behavioral problem. The child had several atypical symptoms of gastroesophageal reflux disease (GERD).[ncbi.nlm.nih.gov]
  • Co-existing FD, sleep disturbances, and alcohol abstinence were significantly associated with P-CAB non-response. Other therapeutic options should be considered in patients with these factors. 2017 S. Karger AG, Basel.[ncbi.nlm.nih.gov]
  • The overall satisfaction rate was 61.8%, and 32.2% of patients experienced nocturnal heartburn and sleep disturbance.[ncbi.nlm.nih.gov]
  • In addition to the cardinal symptoms of heartburn and regurgitation, people with GERD can also have sleep disturbances, chest pains, or respiratory symptoms.[ncbi.nlm.nih.gov]
  • Out of 15 subjects 6 were unrefreshed sleepers with slef-reported sleep disturbance and 9 were controls with no sleep disturbance.[web.archive.org]
Constant Throat Clearing
  • Untreated, GERD can lead to chronic laryngitis, dysphonia, chronic sore throat, chronic cough, constant throat clearing, granuloma of the true vocal cords and other problems.[ncbi.nlm.nih.gov]

Workup

Several techniques are used to diagnose gastroesophageal reflux disease, beginning with a comprehensive patient history. The history should include symptoms, duration, frequency, precipitating and alleviating factors [6].

Laboratory tests are usually not useful or necessary to establish a diagnosis of gastroesophageal reflux disease [1]. The only way to definitively diagnose the disorder is through the presence of elevated pH levels and abnormal pressure using esophageal manometry and pH monitoring [1] [6].

A trial with proton-pump inhibitors (PPI) is now the recommended diagnostic technique in individuals with symptoms [6]. Patients who improve with this therapy are likely to have the disease [6]. In patients unresponsive to this trail therapy another diagnosis should be sought [6].

The following studies are recommended in patients suspected to have gastroesophageal reflux disease [12] [13]:

  • Upper endoscopy
  • Esophageal manometry
  • Twenty-four hour pH monitoring

Manometry measures intraesophageal pressures [6]. It is the primary method for identifying the causative mechanisms of gastroesophageal reflux disease [12].

Imaging studies [12]:

  • Upper gastrointestinal contrast-enhanced studies
  • Chest radiographic to assess pulmonary status and presence of hiatal hernia

Computed tomography scanning, magnetic resonance imaging, or ultrasonography are not usually needed [12]. When serious supraesophageal complications are suspected more invasive diagnostic studies may be needed. These include esophagogastroduodenoscopy, laryngoscopy, and esophageal biopsy [6].

Esophageal Motility Disorder
  • Motility Disorders Deglutition Disorders Esophageal Diseases Gastrointestinal Diseases Digestive System Diseases Signs and Symptoms, Digestive Signs and Symptoms[clinicaltrials.gov]
  • Esophageal motility disorder on manometry 5. Barretts esophagus 6. Reflux esophagitisgrade D Los Angeles classification 7. Current pregnancy 8.[doi.org]
  • Esophageal motility disorder Esophageal motility study Gastroesophageal reflux disease at Curlie Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, Johnson SP, Allen J, Brill JV (October 2008).[en.wikipedia.org]
  • Suter MDorta GGiusti VCalmes JM Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 2004;14959- 966 PubMed Google Scholar Crossref 46.[doi.org]
  • Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg . 2007 Jul. 17(7):894-900. [Medline] . Murray L, Johnston B, Lane A, et al.[emedicine.com]

Treatment

Gastroesophageal reflux disease is treated by a progressive approach moving from lifestyle modification to control of gastric secretion by medication, and finally surgical treatment [1] [2]. Aggressive therapy with proton pump inhibitors, acid suppressive medications, is the recommended initial treatment[1].

The goals of treatment are to control symptoms, heal esophagitis, and prevent recurrent esophageal irritation and other complications. For optimum treatment of gastroesophageal reflux disease it is important to identify the underlying etiology responsible so that the most effective therapy can be initiated.

Lifestyle changes

Lifestyle changes have been proven to be effective in the treatment of gastroesophageal reflux disease [3]. Life modifications include the following [2] [8]:

  • Weight loss, if overweight [7] [8]
  • Avoidance of alcohol, coffee, chocolate, citrus juice, and tomatobased foods
  • Small, frequent meals
  • Wait 3 hours after a meal before lying down
  • Refrain from eating within 3 hours of bedtime
  • Elevate the head of the bed 8 inches [6]
  • Avoid bending or stooping

Pharmacotherapy

The following medications are used in the management of gastroesophageal reflux disease [1] [10]:

  • H2 receptor antagonists: Ranitidine, cimetidine, famotidine, nizatidine
  • Proton pump inhibitors: Omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole
  • Prokinetic agents: Aluminum hydroxide
  • Antacids: Aluminum hydroxide, magnesium hydroxide

Protein pump inhibitors have become the primary intervention for the treatment of gastroesophageal reflux disease. It has proven to be cost-effective and generally safe [1]. A trial course of proton pump inhibitors may be used to help diagnosis the disorder [10]. Recent research has shown that long-term use of proton pump inhibitors may interfere with calcium absorption, but may also reduce bone reabsorption [10]. Standard-dosage of anti-reflux medications does not seem to reduce the incidence of cancer or Barrett’s esophagus [7].

Surgical intervention

Nissen fundoplication is an alternative therapy in patients who do not respond to medication. It involves wrapping the lower esophagus with muscles to increase the tone of the lower esophageal sphincter. However, as with any surgery this procedure may have significant complications [1]. Surgical repair of hiatal hernia is also an effective treatment for chronic gastroesophageal reflux disease [1].

Prognosis

Most patients with gastroesophageal reflux disease do well on medication therapy. Relapse after discontinuation of medication is common and indicates a need for long-term therapy [1] [7].

Surgical interventions, such as laparoscopic Nissen fundoplication may be necessary for patients with gastroesophageal reflux disease not responsive to medication or experiencing serious complications. It has been reported to be effective in approximately 92% of patients [1] [11].

Gastroesophageal reflux is usually benign in infants and very young children and responds to non-pharmacologic or conservative treatment [1].

Complications of chronic gastroesophageal reflux disease include erosive esophagitis, Barrett esophagus, and esophageal adenocarcinoma [2] [7].

Etiology

The etiology of gastroesophageal reflux disease is the excessive movement of gastric secretions, containing gastric acids and bile, from the duodenum and stomach into the esophagus [1] [4]. It is thought to be due to the relaxation of the lower esophageal sphincter or an imbalance in pressure surrounding this sphincter [3] [5].

Normal relaxation of the lower esophageal sphincter occurs with swallowing. Increased transient relaxation of this sphincter can be trigger by [3] [5]:

  • Foods, such as coffee, alcohol, chocolate, fatty meals, 
  • Medications: beta-agonists, nitrates, calcium channel blockers, and anticholinergics
  • Hormones: progesterone, estrogen
  • Nicotine 

In most adults the amount of gastric material refluxed into the esophagus is limited by normal defense mechanisms. These barriers minimize irritation to the esophageal mucosa and reduce symptoms [1]. Normal lower esophageal sphincter function and normal esophageal motility are the basis of these defensives [2].

While gastric reflux occurs in about 70% of adults in the general population, only 20% have symptoms of gastroesophageal reflux disease and erosion of the esophageal mucosa. Some recent studies hypothesize the influence of inherited mucosal resistance to be a factor [3].

Gastroesophageal reflux disease may cause other supra-esophageal symptoms such as laryngitis, asthma, cough, chest pain, and dental erosions [6] [7].

Epidemiology

Gastroesophageal reflux disease is most common in Western societies, probably due to dietary habits and the rate of obesity. The incidence in the United States is as high as 25 to 40% [3] [5]. Prevalence of gastroesophageal reflux disease worldwide ranges from 10 to 20% [8]. A large proportion of individual with gastroesophageal reflux disease are able to control symptoms with over-the-counter medications so the incidence is probably higher [10].

Obese individuals are almost three times more likely to suffer from gastroesophageal reflux disease with a prevalence of about 37% [8] [9].

The incidence is not influenced by race or gender. It occurs with equal frequency in men and women. However, severe symptoms such as Barrett esophagus are higher in men than women, perhaps 2 to 10 times as often [4] [8]. Gastroesophageal reflux disease occurs in all age groups but its prevalence increases in people over the age of 40 [8].

Sex distribution
Age distribution

Pathophysiology

Gastroesophageal reflux disease results from the increased exposure of the esophagus to stomach contents causing mucosal damage and esophageal erosion [5]. The frequency of acid reflux is key to the development of gastroesophageal reflux disease. Reflux occurs most often during the normal lower esophageal sphincter relaxations that follow swallowing [11] [12] [13].
The etiology of gastroesophageal reflux disease is multifactorial with the primary factors [2] [5] [13]:

  • Increased intraabdominal pressure
  • Impaired gastric emptying
  • Decreased lower esophageal sphincter pressure
  • Increased frequency of transient sphincter relaxation
  • Gastric distention
  • Impaired esophageal or gastric clearance

The lower esophageal sphincter, located in the abdomen, is assisted by the diaphragmatic crura, tendon-like attachments, to prevent reflux [11]. When the lower esophageal sphincter migrates into the chest due to the presence of a hiatal hernia this function is lost [12] [13].

Decreased esophageal clearance is a result of poor esophageal motility [12] [13]. Esophageal acid clearance time is the amount of time it takes the esophagus to return to a neutral pH level after acidic reflux [13]. Acid clearance time and esophageal motor function combine to affect the amount of mucosa irritation [13].

Delayed gastric emptying may also be a factor, as it increases the volume and pressure in the stomach until the balance of pressure against the lower esophageal sphincter is disturbed leading to reflux [3] [11].

Esophageal mucosal resistance is a protective mechanism that varies from individual to individual. Some have suggested that this factor has a hereditary basis [3] [11].

Studies have shown that gastroesophageal reflux disease is much more prevalent in obese individuals and that a high body mass index (BMI) is a risk factor for the development of this disorder. The exact reason for this is not fully known. It is thought that hiatal hernia occurs more frequently and intraabdominal pressure increases with obesity [2] [9].

Complications of gastroesophageal reflux disease are usually associated with supraesophageal or upper airway exposure to gastric acid from microaspiration and triggering of the vasovagal reflex [4].

These complications include [2]:

Prevention

The most effective method of preventing gastroesophageal reflux disease and its complications is through the appropriate lifestyle changes [6]. Weight reduction to normal is probably the single most effective single intervention for prevention [8].

Taking antacids immediately after an episode of heartburn may help decrease esophageal exposure time and prevent esophageal damage and complications of gastroesophageal reflux disease [6].
Rinsing with neutral pH mouthwashes, applying fluoride gels and avoiding brushing teeth immediately after reflux episodes may help to prevent dental erosion [6].

Summary

Gastroesophageal reflux disease results from the reflux of gastric contents into the esophagus causing symptoms of heartburn, regurgitation, and dysphagia [1] [2]. It is associated with esophagitis, laryngitis, and dental erosion. Other symptoms may accompany this disease including non-cardiac chest pain, asthma, pneumonia, hoarseness, and aspiration [2].

Reflux of small amounts of stomach contents into the esophagus is a normal physiologic occurrence experienced by most people intermittently. Gastroesophageal reflux disease (GERD) occurs when this process is abnormal and excessive amounts of gastric acid or mucosal exposure time are extended [1] [2].

Gastroesophageal reflux disease is estimated to occur in 25-40% of healthy American adults [3]. At least, 7-10% of these people experiences symptoms on a daily basis [2].

Complications of gastroesophageal reflux disease include chronic painful esophagitis, appetite disturbances, dental erosion, asthma, and potentially esophageal cancer [3] [4].

Patient Information

What is gastroesophageal reflux disease?

Gastroesophageal reflux disease refers to symptoms resulting from an abnormal backflow of stomach contents into the esophagus. This fluid contains gastric acids and bile. Both of these substances cause irritation, inflammation, and erosion of the mucosa of the esophagus.

What are the symptoms?

The typical symptoms of gastroesophageal reflux disease include:

Other less frequent symptoms of this disorder are:

What causes gastroesophageal reflux disease?

The cause of gastroesophageal reflux disease is the abnormal backflow of gastric acid into the esophagus. The reasons for this are multiple and are different for each patient. Factors that influence reflux include:

  • Lifestyle: Diet, alcohol, caffeine, obesity
  • Structural abnormalities: Hiatal hernia
  • Mechanical abnormalities: Poor lower esophageal sphincter function, decreased esophageal motility

Who gets gastroesophageal reflux disease?

Approximately 10 to 20% of the adults in the United States suffer from gastroesophageal reflux disease. It occurs at all ages, equally in men and women and in all races and ethnic groups. Obese individuals are at higher risk of this disorder as it occurs three times more often in those who are overweight. Gastroesophageal reflux disease occurs most frequently in Western societies probably due to diet and the prevalence of obesity.

How is gastroesophageal reflux disease diagnosed?

Gastroesophageal reflux disease is generally suspected on the basis of patient history and symptoms. Two procedures are useful in diagnosing the disorder: monitoring of the pH, acid concentration, in the esophagus and manometry, that measures the functioning of the lower esophageal sphincter.
Today diagnosis is often made by a non-invasive means with a trial of anti-reflux medication. A relief of symptoms with medication confirms the diagnosis.

How is gastroesophageal reflux disease treated?

Gastroesophageal reflux disease may be treated in three ways:

  • Lifestyle changes: Avoiding  high acid foods, citrus, fatty foods, chocolate, alcohol, caffeine, and nicotine
  • Medications: Antacids, anti-reflux medications, and acid suppressors
  • Surgery to repair esophageal sphincter abnormalities and hiatal hernia

What are the complications?

There are many possible complications of gastroesophageal reflux disease. They include:

How can gastroesophageal reflux disease be prevented?

Prevention of gastroesophageal reflux disease depends upon the underlying cause of the disorder. The most effective method of preventing gastroesophageal reflux disease and its complications is through the appropriate lifestyle changes. Weight reduction to normal is probably the single most effective intervention for prevention. Taking antacids immediately after an episode of heartburn may help decrease esophageal damage. Rinsing with neutral pH mouthwashes, applying fluoride gels and avoiding brushing teeth immediately after reflux episodes may help to prevent dental erosion.

References

Article

  1. Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V. Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol. 2008;103(2):267-75.
  2. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux diseaseand its complications. Ann Intern Med. 2005;143(3):199-211.
  3. Quigley EM. New developments in the pathophysiology of gastro-oesophageal reflux disease (GASTROESOPHAGEAL REFLUX DISEASE): implications for patient management. Aliment Pharmacol Ther. 2003; 17 (Suppl. 2): 43–51.
  4. Fass R, Achem SR, Harding S, Mittal RK, Quigley E. Review article: supra-oesophageal manifestations of gastro-oesophageal reflux disease and the role of night-time gastro-oesophageal reflux. Aliment Pharmacol Ther. 2004; 20 (Suppl. 9): 26–38.
  5. Boeckxstaens GE. Review article: the pathophysiology of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007; 26, 149–160.
  6. Farrokhi F, Vaezi MF. Extra-esophageal manifestations of gastroesophageal reflux. Oral Diseases. 2007;13:349–359.
  7. Talley NJ. Review article: gastro-oesophageal reflux disease — how wide is its span? Aliment Pharmacol Ther.2004; 20 (Suppl. 5): 27–37.
  8. Singh M, Lee J, Gupta N, Gaddam S, Smith BK, Wani SB, et al. Weight Loss Can Lead to Resolution of gastroesophageal reflux diseaseSymptoms: A Prospective Intervention Trial. Obesity. 2013; 21, 284-290.
  9. Murray L, Johnston B, Lane A, Harvey I, Donovan J, Nair P, et al. Relationship between body mass and gastro-oesophageal reflux symptoms: The Bristol Helicobacter Project. Int J Epidemiol. 2003;32(4):645-50.
  10. Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296(24):2947-53.
  11. Mittal RK, Rochester DF, McCallum RW. Effect of the diaphragmatic contraction on lower oesophageal sphincter pressure in man. Gut. 1987;28(12):1564-8.
  12. Dent J. Pathogenesis of gastro-oesophageal reflux disease and novel options for its therapy. Neurogastroenterol Motil. 2008; 20 (Suppl. 1): 91–102. 
  13. Lipan MJ, Reidenberg JS, Laitman JT. Anatomy of Reflux: A Growing Health Problem Affecting Structures of the Head and Neck. The Anatomical Record (Part B: New Anat.). 2006; 289B: 261–270.

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Last updated: 2018-06-21 18:38