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General Illness Information

Common Name:
Hiatus hernia, Gastro-esophageal reflux disease, GERD

Medical Term:

 Gastro-esophageal reflux Disease.
Description:

Reflux of stomach and duodenal contents into the esophagus, with or without esophageal inflammation. This is a common condition.

65% of adults have suffered heartburn; 24% have had symptoms for > 10 years. 

All ages are affected. Males and females suffer equally.
Causes: Inappropriate relaxation of lower esophageal sphincter.

· Familial clustering of GERD has been described suggesting a possible genetic basis

· Pregnancy 

· Scleroderma (reduced esophageal motility and incompetent LES)

· Chalasia of infancy

· Delayed gastric emptying (impaired acid clearance)

· Acid hyper secretion (e.g., Zollinger-Ellison syndrome).
Prevention:

Long-term maintenance therapy with H2 blockers or proton pump inhibitors along with lifestyle and diet modifications to prevent symptomatic relapse.
Signs & Symptoms
Heartburn  70-80%

Regurgitation 60%

Dysphagia (difficulty swallowing) 15%

Angina-like chest pain 33%

Bronchospasm (asthma) 15-20%

Laryngitis -like symptoms

Chronic cough

 

Risk Factors

Foods that lower LES pressure (high-fat content, yellow onions, chocolate, peppermint)

· Foods that irritate esophageal mucosa (citrus fruits, spicy tomato drinks) · Hiatal hernia - acid trapping

· Cigarette smoking; excessive alcohol; coffee

· Medications that lower LES pressure (e.g., theophylline, anticholinergics,progesterone, calcium channel blockers (nifedipine, verapamil). 
Diagnosis & Treatment
Esophageal pH monitoring.

Esophageal manometry.

Acid perfusion (Bernstein) test

Gastric analysis.

IMAGING:

Barium swallow.

Radionuclide scintigraphy

DIAGNOSTIC PROCEDURES:

Endoscopy in chronic GERD patients to exclude Barrett's (see below), etc. is becoming an accepted practice
General Measures:
Elevate head of bed, avoid lying down directly after meals; avoid stooping, bending, tight-fitting garments

Avoid drugs causing decreased LES pressure

Weight loss.

Do not smoke or take alcohol.

Do not eat spicy foods, citrus etc.

Eat frequent small meals.

Do not eat just before bedtime.
Medications:
H2 Blockers such as Ranitidine, or Proton Pump Inhibitors, such as Losec (prilosec), or  Prevacid, once or twice daily.

Surgery for complications such as Barrett's Esophagus

Activity:
As Tolerated.
Diet:
See general measures above.
Possible Complications :
Peptic stricture (10-15%)

· Hemorrhage (3%)

· Barrett's esophagus (10%)

· Pulmonary or ear, nose, throat complications (5-10%)

· Noncardiac chest pain

· Adenocarcinoma from Barrett's epithelium

 
Prognosis

Good, with appropriate treatment.