Gastroesophageal Reflux Disease
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 sex and symptoms of GERD in North America.
- Advanced age increases your risk of GERD; >50 versus <50 years old, odds ratio (OR) of 1.32 (95% CI, 1.46–2.06) of having GERD (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
General Prevention
- Change of diet: 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
- Staying 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
- Nonerosive and erosive esophagitis, the latter occurs in 18–25% of patients with GERD (1).
- Barrett esophagus: prevalence of 7% (95% CI, 5%–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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Citation
Domino, Frank J., et al., editors. "Gastroesophageal Reflux Disease." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/all/Gastroesophageal_Reflux_Disease.
Gastroesophageal Reflux Disease. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/all/Gastroesophageal_Reflux_Disease. Accessed December 3, 2024.
Gastroesophageal Reflux Disease. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/all/Gastroesophageal_Reflux_Disease
Gastroesophageal Reflux Disease [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117515/all/Gastroesophageal_Reflux_Disease.
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T1 - Gastroesophageal Reflux Disease
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ED - Baldor,Robert A,
ED - Golding,Jeremy,
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