Gastroesophageal Reflux Disease

Descriptive text is not available for this image BASICS

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

  • The prevalence of GERD in North America is ~15% (95% CI, 10.7–20.9%) (1).
  • There is no association between gender and symptoms of GERD in North America.
  • Advanced age increases risk of GERD; >50 years old, odds ratio (OR) of 1.32 (95% CI, 1.46–2.06) (1)
  • Pediatric population: Regurgitation occurs in nearly 50% of newborn infants, resolving spontaneously in 90% of children by age 1 year (1).

ETIOLOGY AND PATHOPHYSIOLOGY

  • Stomach acid contacts the squamous mucosal lining of the esophagus, which is less acid resistant than gastric columnar mucosa, followed by release of chemokines and cytokines causing symptoms and disease.
  • GERD can be the result of one or a combination of the following: lower esophageal sphincter (LES) dysfunction, esophageal hypersensitivity, delayed gastric emptying, and increased gastroesophageal junction distensibility.
  • Patients with severe GERD often have evidence of a hiatal hernia which can trap acid, impair acid emptying, reduce LES pressure, and increase retrograde acid flow.

Genetics

Genetic heterogeneity may account for 31–43% of the predisposition to develop GERD (2).

RISK FACTORS

  • Obesity; OR of 1.7 (95% CI, 1.4–2.1) (1)
    • Higher prevalence of hiatal hernia; increased intra-abdominal pressure, bile, and pancreatic enzymes
  • Tobacco use; OR of 1.2 (95% CI, 1.04–1.5) (1)
  • Hiatal hernia
  • Pregnancy
  • Diet; alcohol use
  • Scleroderma; neuromuscular disorders

GENERAL PREVENTION

  • Weight loss (1)[A],(2)[A]
  • Tobacco cessation (1)[B]
  • Decrease consumption of spicy, acidic and fatty foods, alcoholic and carbonated beverages, chocolate, and caffeine (2)[C].
  • Elevate head of bed at night for selected patients (2)[C].
  • Avoid meals within 2 to 3 hours of bedtime (2)[C].
  • Smaller portions
  • Remain upright during and after meals
  • Infants: Use car seat for 2 to 3 hours after meals, thickened feedings, burp frequently while feeding

COMMONLY ASSOCIATED CONDITIONS

  • Erosive esophagitis occurs in 18–25% of patients with GERD (1).
  • Barrett esophagus: prevalence of 7% (95% CI, 5% to 9%) in patients with GERD (1)
  • Esophageal adenocarcinoma
  • Peptic ulcer disease (PUD)
  • Peptic esophageal stricture
  • Extraesophageal reflux: asthma, aspiration, chronic cough, laryngitis, vocal cord granuloma, sinusitis, otitis media
  • Halitosis

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