Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease
Other names	GERD, Acid reflux, Heartburn
Specialty	Gastroenterology

Gastroesophageal Reflux Disease (GERD), also known as acid reflux or heartburn, is a long-term condition where stomach contents come back up into the esophagus resulting in either symptoms or complications. Symptoms include the taste of acid in the back of the mouth, heartburn, bad breath, chest pain, vomiting, breathing problems, and wearing away of the teeth. Complications may include esophagitis, esophageal stricture, and Barrett's esophagus.

Causes

GERD is caused by a failure of the lower esophageal sphincter (LES), which is responsible for sealing off the stomach from the esophagus. Factors that can contribute to the dysfunction of the LES include obesity, certain medications, smoking, and dietary choices. Additionally, a hiatal hernia can often lead to GERD.

Pathophysiology

In GERD, the lower esophageal sphincter becomes weak or relaxes inappropriately, allowing the stomach's contents to flow up into the esophagus. The stomach produces a strong acid to aid in digestion and protect against pathogens; however, in the case of reflux, this acid can damage the lining of the esophagus, leading to the symptoms and complications associated with GERD.

Diagnosis

Diagnosis of GERD is typically made based on the symptoms presented. A detailed medical history and physical examination are sufficient in most cases. In certain situations, tests such as an endoscopy, a barium swallow radiograph, and esophageal pH monitoring may be required to confirm the diagnosis or to identify complications.

Treatment

The management of GERD includes lifestyle changes, medications, and occasionally surgery. Lifestyle changes might involve modifications to diet, elevating the head during sleep, and avoiding substances that trigger reflux such as alcohol and tobacco. Medications commonly used include proton pump inhibitors (PPIs), H2 receptor antagonists, and antacids. Surgery may be an option for those who do not improve with other measures.

Epidemiology

GERD is common globally. It affects about 10 to 20 percent of the Western world and is less common in Asia. GERD has increased in prevalence in recent years.

See also

• Esophagitis
• Barrett's esophagus
• Hiatal hernia
• Stomach acid
• Proton pump inhibitor