Description

• Changes of the esophageal mucosa resulting from reflux of gastric contents into the esophagus
• Often described as “heartburn,” “acid indigestion,” and “acid reflux”

Epidemiology

Incidence
Incidence: 5/1,000 person-years

Prevalence

• 10–20% in the United States
• Chronic GERD is a risk factor for Barrett esophagus.
• Risk of adenocarcinoma without Barrett esophagus and no dysplasia: 0.1–0.5% per patient-year
• Risk of adenocarcinoma with Barrett esophagus and high-grade dysplasia: 6–19% per patient-year
• Pediatric population: Regurgitation occurs at least once a day in 2/3 of 4-month-old infants, decreasing to 21% at age 6 to 7 months, and 5% at 10 to 12 months.

Etiology and Pathophysiology

• The pattern and mechanism of reflux varies depending on the severity of disease.
• GERD begins when acidic stomach contents contact the squamous mucosal lining of the esophagus, at the esophagogastric junction (EGJ).
• Inappropriate transient lower esophageal sphincter (LES) relaxation. Foods that are spicy; acidic; and high in fat, caffeine, alcohol, tobacco, anticholinergic medications, nitrates, smooth muscle relaxants affect LES relaxation.
• Patients with severe GERD often have evidence of a hiatal hernia, which can:
  • Trap acid in the hernia sac
  • Impair acid emptying
  • Increase retrograde acid flow rate
  • Reduce the EGJ sphincter pressure
  • Increase frequency of transient LES relaxations

Genetics
Genetic heterogeneity has been associated with GERD.

Risk Factors

• Obesity
• Hiatal hernia
• Scleroderma
• Alcohol use
• Tobacco use
• Pregnancy

General Prevention

• Decrease consumption of food and beverage triggers such as spicy, fatty foods, alcohol, and caffeine.
• Weight loss
• Avoid lying down after meals.
• Eliminate tobacco and alcohol cessation.
• Elevate head of bed at night.
• Avoid meals close to bedtime.
• Infants: Use car seat for 2 to 3 hours after meals; thickened feedings

Commonly Associated Conditions

• Nonerosive esophagitis
• Erosive esophagitis
• Irritable bowel syndrome
• Peptic ulcer disease
• Extraesophageal reflux: aspiration, chronic cough, laryngitis, vocal cord granuloma, sinusitis, otitis media
• Halitosis
• Hiatal hernia: acid pocket (zone of high acidity in the proximal stomach above the diaphragm) (1)[B]
• Peptic stricture: 10% of patients with GERD
• Barrett esophagus
• Esophageal adenocarcinoma