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
- The prevalence of GERD in North America is 15.4% (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.
Genetic heterogeneity may account for 31–43% of the predisposition to develop GERD (2).
- 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 7.2% (95% CI, 5.4%–9.3%) 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
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