Gastro-Esophageal Reflux Disease (GERD)

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.


  • 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).


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.


  • Barium swallow;
  • Radionuclide scintigraphy


  • 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.


  • 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


As Tolerated.


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.


Good, with appropriate treatment.

Posted by

Connected Medications :

Gaviscon (Alginic Acid)

GAVISCON® Heartburn Relief Formula SmithKline Beecham Consumer Healthcare Alginic Acid Compound Gastroesophageal Reflux Disease Therapy Action And Clinical Pharmacology: The liquid or tablets, when chewed,…

Peptol (Cimetidine)

PEPTOL® Carter Horner Cimetidine Histamine H2 Receptor Antagonist Action And Clinical Pharmacology: Cimetidine inhibits competitively the action of histamine at the histamine H2 receptor and…

Losec (Omeprazole Magnesium)

LOSEC® Astra Omeprazole Magnesium H KATPase Inhibitor Note: When used in combination with amoxicillin, clarithromycin or metronidazole, the product monographs for those agents must be…

Zantac 75 (Ranitidine HCl)

ZANTAC® 75 Glaxo Wellcome Ranitidine HCl Histamine H2-receptor Antagonist Action And Clinical Pharmacology: Ranitidine is an antagonist of histamine at gastric H2-receptor sites. Thus, ranitidine…

Pylorid (Ranitidine Bismuth)

gasPYLORID® Glaxo Wellcome Ranitidine Bismuth Citrate Histamine H2-receptor Antagonist with H. pylori Suppressive Activity Note: For additional safety information on clarithromycin and ranitidine, consult the…