Gastroesophageal reflux disease

Definition

Gastroesophageal reflux disease (GERD) is a condition in which food or liquid travels from the stomach back up into the esophagus (the tube from the mouth to the stomach). This partially digested material is usually acidic, and can irritate the esophagus, often causing heartburn and other symptoms.

Causes, incidence, and risk factors

Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn't close properly, food and liquid can move backward into the esophagus and may cause the symptoms.

The risk factors for reflux include hiatal hernia, pregnancy, and scleroderma.

Symptoms

• Heartburn
  • Involves a burning pain in the chest (under the breastbone)
  • Increased by bending, stooping, lying down, or eating
  • Relieved by antacids
  • More frequent or worse at night
• Belching
• Regurgitation of food
• Nausea and vomiting
• Vomiting blood
• Hoarseness or change in voice
• Sore throat
• Difficulty swallowing
• Cough or wheezing

Signs and tests

• A positive stool guaiac
• Continuous esophageal pH monitoring showing reflux
• Endoscopy showing ulceration or inflammation of the esophagus
• Esophageal manometry showing abnormal sphincter pressure
• A barium swallow showing reflux
• A positive Bernstein test for gastric acid reflux

Treatment

General measures include:

• Weight reduction
• Avoiding lying down after meals
• Sleeping with the head of the bed elevated
• Taking medication with plenty of water
• Avoiding dietary fat, chocolate, caffeine, peppermint (they may cause lower esophageal pressure)
• Avoiding alcohol and tobacco

• Antacids after meals and at bedtime
• Histamine H2 receptor blockers
• Promotility agents
• Proton pump inhibitors

Expectations (prognosis)

The majority of people respond to nonsurgical measures with behavioral modification and medications.

Complications

• Inflammation of the esophagus
• Stricture
• Esophageal ulcer
• Hoarseness, bronchospasm
• Chronic pulmonary disease
• Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)

Calling your health care provider

Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.

Prevention

Avoid foods and activities that worsen symptoms. Maintain a healthy weight.

Illustrations

Digestive system

Gastroesophageal reflux disease

Upper gastrointestinal system

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