Gastroesophageal Reflux Disorder
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Introduction
Gastroesophageal Reflux Disorder (GERD) is the most common problem of the esophagus. causing occasional heartburn in nearly half the population and daily symptoms of almost 15% of people.
GERD occurs when the esophageal is exposed to acid-containing gastric secretions.
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Causes and Risk Factors
Hiatal hernias can contribute to GERD, but they can occur independently of each other.
Eating close to bedtime, fatty or spicy foods, cigarettes, alcohol, and obesity can all cause GERD.
Pathophysiology
several mechanisms
decreased saliva production
transient LES relaxations (TLER's) (normal)
hiatus hernia
mucosal hypersensitivity
decreased resting LES tone (obesity, scleroderma)
diet decreased LES tone (caffeine, alcohol, peppermint); decreased gastric emptying (high fat diet), large meals (most Maritimers)
Signs and Symptoms
- history
- physical exam
History
Heartburn/reflux is the cardinal feature of GERD. Other symptoms can include
- chronic cough, asthma, hoarseness, chronic sore throat, and globus sensation
non-cardiac chest pain
waterbrash - flush of saliva
dyspepsia
nausea
frank regurgitation
Red Flags
weight loss, bleeding (anemia), dysphagia, melena, hematemesis, progressive symptoms
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Lifestyle
give up alcohol, caffeine, nicotine, and a high-fat diet.
sleep with the head of the bed up a bit
loose clothes
medications
proton pump inhibitors (omeprazole, lansoprazole). PPIs do not prevent reflux, but rather reduce the
H2 receptor blockers (ranitidine, cimetidine)
misoprostol, in combination with NSAIDs
sulcrate
Screen for dysplasia every 2-3 years
surgery
Nissen fundiplication is used for the vast majority of patients for whom surgery is indicated:
- documented reflux with esophagitis and Barrett's esophagus
- failed medical management
Success rates are 90% at 10 years.
Consequences and Course
Complications can include pain, bleeding, strictures, or Barrett's esophagus or carcinoma.
Sore throat, laryngitis, asthma can be common.
reactive atypia has no malignant potential and is due to inflammation.
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Additional Resources
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