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.

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.

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