Gastroesophageal reflux disease

Gastroesophageal reflux disease

Definition:

Gastroesophageal reflux disease (GERD) is when 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.

Alternative Names:

Peptic esophagitis; Reflux esophagitis; GERD; heartburn - chronic

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.

Some conditions are associated with incompetent esophageal sphincters, including pregnancy, hiatal hernia, obesity, recurrent or persistent vomiting and nasogastric tubes. Risk factors for reflux include previous esophageal surgery or esophageal stricture.

Symptoms:

Heartburn
- Involves a burning pain in the chest (under the breastbone)
- Increased by bending, stooping, lying down, or eating
- Relieved by milk or 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

Medications that alleviate symptoms include:

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

Anti-reflux operations (Nissen fundoplication) may help a small number of patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux.

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 and/or medication.

Prevention:

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

Review Date: 9/23/2002
Reviewed By: A.D.A.M. editorial. Previous review: Andrew J. Muir, M.D. M.H.S., Division of Gastroenterology, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network (4/25/02).

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