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.
Posted by RxMed