Gastroesophageal Reflux Disease
- Changes of the esophageal mucosa resulting from reflux of gastric contents into the esophagus
- Often described as “heartburn,” “acid indigestion,” and “acid reflux”
Incidence: 5/1,000 person-years
- 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
Genetic heterogeneity has been associated with GERD.
- Hiatal hernia
- Alcohol use
- Tobacco use
- 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
- Peptic stricture: 10% of patients with GERD
- Barrett esophagus
- Esophageal adenocarcinoma
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Domino, Frank J., et al., editors. "Gastroesophageal Reflux Disease." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/1.3/Gastroesophageal_Reflux_Disease.
Gastroesophageal Reflux Disease. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/1.3/Gastroesophageal_Reflux_Disease. Accessed May 31, 2023.
Gastroesophageal Reflux Disease. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/1.3/Gastroesophageal_Reflux_Disease
Gastroesophageal Reflux Disease [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 31]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/1.3/Gastroesophageal_Reflux_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gastroesophageal Reflux Disease ID - 117515 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/1.3/Gastroesophageal_Reflux_Disease PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -