Gastroesophageal reflux disease is a common condition caused by the reflux of gastric contents into the esophagus.
Presentation
Patients with gastroesophageal reflux disease usually present with heartburn and acid regurgitation into the esophagus [1]. A minority of patients present with supraesophageal symptoms such as dental erosions, laryngitis, asthma, cough, or non-cardiac chest pain [1].
Gastroesophageal reflux disease-related complications include erosive esophagitis, Barrett esophagus, and esophageal adenocarcinoma [2].
The typical symptoms of gastroesophageal reflux disease include [1] [2] [5]:
- Heartburn
- Regurgitation
- Dysphagia
Atypical (supraesophageal) symptoms include the following [2] [4]:
- Coughing and/or wheezing
- Throat clearing
- Apnea
- Aspiration pneumonia
- Bronchitis
- Hoarseness, sore throat
- Otitis media
- Non-cardiac chest pain
- Enamel erosion or other dental problems
Entire Body System
- Weight Gain
Blood and urine tests can help identify or rule out possible causes of recurring vomiting and poor weight gain. Esophageal pH monitoring. [mayoclinic.org]
No edema of lower limbs or weight gain occurred. No adverse reactions related to the testing drug had been reported and all the authors concluded that alginate was safe for the unborn baby. [ncbi.nlm.nih.gov]
Feeding smaller, more frequent amounts can also be helpful so long as your baby continues to gain weight. Children with GERD may benefit from avoiding fatty or fried foods. [jamanetwork.com]
However, GERD may merit treatment when your child has: frequent vomiting that results in poor weight gain and growth pain that interferes with daily functioning complications of reflux such as inflammation (esophagitis), ulcers (sores) that form in the [childrenshospital.org]
Esophageal conditions include vomiting, poor weight gain, dysphagia, abdominal or substernal/retrosternal pain, and esophagitis. [pediatrics.aappublications.org]
- Recurrent Otitis Media
Conversely, no conclusive clinical evidence supports a link between gastroesophageal reflux and other supraesophageal problems, including otalgia, recurrent otitis media, and chronic sinusitis. [emedicine.medscape.com]
otitis media Heartburn and regurgitation are the characteristic symptoms of GERD. [hindawi.com]
- Arm Pain
[…] jaw or arm pain. [mayoclinic.org]
Respiratoric
- Cough
A minority of patients present with supraesophageal symptoms such as dental erosions, laryngitis, asthma, cough, or non-cardiac chest pain. [symptoma.com]
This case suggests cough as an adverse drug event to omeprazole, which is otherwise commonly prescribed for the management of GERD-related cough. [ncbi.nlm.nih.gov]
- Hoarseness
Other symptoms may accompany this disease including non-cardiac chest pain, asthma, pneumonia, hoarseness, and aspiration. [symptoma.com]
Other symptoms of GERD include: Increase in saliva Chest pain Chronic dry coughing Nausea Bad breath Hoarseness Laryngitis When acid reflux enters the throat beyond the upper esophageal sphincter, it can cause a sore throat and lead to hoarseness. [manhattangastroenterology.com]
Other symptoms may include coughing, frequent clearing of the throat, difficulty in swallowing ( dysphagia ), hoarseness, or exacerbation of asthma. [britannica.com]
· Especially in individuals who have symptoms at night or in the throat (e.g. hoarseness, throat clearing), elevation of the head of the bed by 6-8 inches may be helpful. [infantrisk.com]
- Sore Throat
Learn More About Topic Sore Throats Everybody gets a sore throat now and then. When you have a sore throat, this can affect speaking, swallowing, or breathing. [entnet.org]
Untreated, GERD can lead to chronic laryngitis, dysphonia, chronic sore throat, chronic cough, constant throat clearing, granuloma of the true vocal cords and other problems. [ncbi.nlm.nih.gov]
Heartburn sufferers may also experience a sore throat, hoarseness, chronic cough, asthma or a feeling of a lump in the throat. Because there can be chest pain associated with GERD, heartburn sometimes is mistaken for heart attack. [medstarmontgomery.org]
The typical symptoms of gastroesophageal reflux disease include: Heartburn Regurgitation Dysphagia Other less frequent symptoms of this disorder are: Coughing or wheezing Throat clearing Aspiration pneumonia Bronchitis Hoarseness, sore throat Ear pain [symptoma.com]
- Dry Cough
A persistent regurgitation of the acid into the throat and back of the mouth particularly at night may lead to a persistent dry cough. This occurs because the back of the throat is irritated. [news-medical.net]
Other symptoms of GERD include: Increase in saliva Chest pain Chronic dry coughing Nausea Bad breath Hoarseness Laryngitis When acid reflux enters the throat beyond the upper esophageal sphincter, it can cause a sore throat and lead to hoarseness. [manhattangastroenterology.com]
Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing. Anyone, including infants and children, can have GERD. If not treated, it can lead to more serious health problems. In some cases, you might need medicines or surgery. [medlineplus.gov]
Common clinical features in adults include epigastric and retrosternal burning sensations (heartburn or pyrosis), regurgitation leaving an acidic taste in the mouth, waterbrash (increased salivation), enamel erosions, and a chronic dry cough 1. [radiopaedia.org]
- Non-Cardiac Chest Pain
In addition to typical reflux symptoms, it can also be used for diagnostic purposes in patients with non-cardiac chest pain (NCCP). [ncbi.nlm.nih.gov]
The symptoms non-cardiac chest pain, dysphagia, globus, dyspepsia, cough, wheezing and hoarseness, have all been reported to be associated with GERD. [hon.ch]
Chest pain may be a symptom of GERD, even the presenting symptom (2,3). Distinguishing cardiac from non-cardiac chest pain is required before considering GERD as a cause of chest pain. [gi.org]
Non-cardiac chest pain caused by GORD has been found in up to 50% of patients with chest pain and normal coronary angiography. [patient.info]
Gastrointestinal
- Regurgitation
This simple act of acid regurgitation has also been implicated in a large number of other problems. [cdlsworld.org]
Regurgitation and vomiting can be further differentiated from rumination, in which recently ingested food is effortlessly regurgitated into the mouth, masticated, and reswallowed. [pediatrics.aappublications.org]
Patients with gastroesophageal reflux disease usually present with heartburn and acid regurgitation into the esophagus. [symptoma.com]
Acid regurgitation is the sensation of stomach fluid coming up through the chest which may reach the mouth. [asge.org]
The ability of DM patients to feel acid regurgitation may be decreased. [ncbi.nlm.nih.gov]
- Vomiting
Some infants with reflux will not be able to gain weight due to frequent vomiting. [stanfordchildrens.org]
It is recognized that upper GI tract series are useful in the evaluation of vomiting to screen for possible anatomic abnormalities of the upper GI tract. 4 For example, in infants with bilious vomiting, an upper GI tract series may be useful for evaluating [pediatrics.aappublications.org]
Some babies with reflux will not be able to gain weight due to frequent vomiting. [chop.edu]
More LNF patients were unable to belch (8.5% of MSA and 25.5% of LNF; p= 0.028) or vomit (4.3% of MSA and 21.3% of LNF; p=0.004). §§ Reynolds J, Zehetner J, Wu P, et al. [toraxmedical.com]
- Dysphagia
We also performed a subgroup analysis of the outcomes parameters dysphagia and recurrence of acid reflux in studies with follow-up higher than 2 years. publication bias was tested using a funnel plot in the outcomes dysphagia and recurrence of acid reflux [doi.org]
Outcomes selected were recurrent or persistent postoperative dysphagia and an abnormal 24-hour pH test result. [ncbi.nlm.nih.gov]
The most frequent adverse event was dysphagia, which occurred in 68% of patients ( Figure 3C and Table 2 ). Ongoing dysphagia was noted in 11% of patients at 1 year, in 5% at 2 years, and in 4% at 3 years. [nejm.org]
- Dysphagia
We also performed a subgroup analysis of the outcomes parameters dysphagia and recurrence of acid reflux in studies with follow-up higher than 2 years. publication bias was tested using a funnel plot in the outcomes dysphagia and recurrence of acid reflux [doi.org]
Outcomes selected were recurrent or persistent postoperative dysphagia and an abnormal 24-hour pH test result. [ncbi.nlm.nih.gov]
The most frequent adverse event was dysphagia, which occurred in 68% of patients ( Figure 3C and Table 2 ). Ongoing dysphagia was noted in 11% of patients at 1 year, in 5% at 2 years, and in 4% at 3 years. [nejm.org]
- Nausea
Symptoms Heartburn A burning sensation in your chest Reflux Backing up of stomach acids that may taste sour or bitter Dyspepsia Stomach discomfort with nausea or bloating after eating Shortness of breath Feeling that you cannot get enough air Symptoms [ctsurgerypatients.org]
[…] tetracycline-type antibiotic calcium carbonate Alka-Mints, Caltrate, Rolaids, Tums Chalky taste; constipation; excessive and prolonged doses may cause difficult, painful, or frequent urination, appetite loss, mood changes, muscle pain or twitching, nausea [health.harvard.edu]
Other risks reported after anti-reflux surgery procedures include bloating, nausea, dysphagia (difficulty swallowing), odynophagia (painful swallowing), retching, and vomiting. [toraxmedical.com]
Jaw & Teeth
- Tooth Erosion
Tooth erosion and wear are common oral manifestations of GERD. [ncbi.nlm.nih.gov]
GERD is a chronic disorder of the digestive system caused by the lower esophageal sphincter (LES) not closing properly, allowing stomach acid into your esophagus, causing inflammation and in some cases, tooth erosion. [verywellhealth.com]
[citation needed] Mouth[edit] Frontal view of severe tooth erosion in GERD.[17] Severe tooth erosion in GERD.[17] Acid reflux into the mouth can cause breakdown of the enamel, especially on the inside surface of the teeth. [en.wikipedia.org]
Cardiovascular
- Chest Pain
All the symptoms except chest pain were improved dramatically by speech therapy and empirical treatment for GERD. [ncbi.nlm.nih.gov]
People with GERD often report chest pain, commonly known as heartburn. People who are having a heart attack — or certain other heart problems — also often experience chest pain. Chest pain caused by reduced blood flow to your heart is called angina. [everydayhealth.com]
Pain upon swallowing. Hoarseness or wheezing from regurgitation into the throat and lungs. Chest pain, thought to be due to an esophageal spasm set off by acid irritating the esophagus. Note: Heartburn and heart attack have overlapping symptoms. [healthcentral.com]
For the meaning "pain in or near the heart", see Chest pain and Angina. [en.wikipedia.org]
- Retrosternal Chest Pain
Numerous other manifestations related to gastroesophageal reflux and considered atypical have been described, such as retrosternal chest pain without evidence of coronary artery disease, asthma, chronic cough, hoarseness, etc. (92). 1) Should adult patients [scielo.br]
Ears
- Otalgia
Conversely, no conclusive clinical evidence supports a link between gastroesophageal reflux and other supraesophageal problems, including otalgia, recurrent otitis media, and chronic sinusitis. [emedicine.medscape.com]
[…] wireless capsule is scarcely available. 5) Should all patients with atypical manifestations (non-cardiac chest pain, globus, asthma, chronic cough, bronchitis, bronchiectasis, recurrent pneumonia, hoarseness, "throat clearing", laryngitis, sinusitis, otalgia [scielo.br]
Neurologic
- Sleep Disturbance
A 2.5-year-old child presented with a sleep disturbance initially diagnosed as a behavioral problem. The child had several atypical symptoms of gastroesophageal reflux disease (GERD). The sleep disturbance resolved quickly after treatment of GERD. [ncbi.nlm.nih.gov]
Along with heartburn and chest pain, other symptoms and signs may occur in older children and adolescents, such as regurgitation, epigastric pain, food refusal, dysphagia, impaired quality of life, sleeping disturbances, anorexia, and dental erosions. [intechopen.com]
- Constant Throat Clearing
Untreated, GERD can lead to chronic laryngitis, dysphonia, chronic sore throat, chronic cough, constant throat clearing, granuloma of the true vocal cords and other problems. [ncbi.nlm.nih.gov]
(often recurring and serious) idiopathic pulmonary fibrosis, a restrictive lung disease where lung scarring occurs sleep disorders constant throat clearing Some people with GERD have mild symptoms that can be treated successfully by lifestyle changes, [healthline.com]
Urogenital
- Kidney Failure
Such conditions are:[18][19] Fetor hepaticus: an example of a rare type of bad breath caused by chronic liver failure. Lower respiratory tract infections (bronchial and lung infections). Kidney infections and kidney failure. Carcinoma. [en.wikipedia.org]
- Incontinence
Hiatal insufficiency and concentric hiatal hernia are determinant factors of irreversible incontinence of the cardia (85). Comments. The presence of a hiatal hernia requires higher doses of PPI for the clinical treatment. [scielo.br]
Workup
Several techniques are used to diagnose gastroesophageal reflux disease, beginning with a comprehensive patient history. The history should include symptoms, duration, frequency, precipitating and alleviating factors [6].
Laboratory tests are usually not useful or necessary to establish a diagnosis of gastroesophageal reflux disease [1]. The only way to definitively diagnose the disorder is through the presence of elevated pH levels and abnormal pressure using esophageal manometry and pH monitoring [1] [6].
A trial with proton-pump inhibitors (PPI) is now the recommended diagnostic technique in individuals with symptoms [6]. Patients who improve with this therapy are likely to have the disease [6]. In patients unresponsive to this trail therapy another diagnosis should be sought [6].
The following studies are recommended in patients suspected to have gastroesophageal reflux disease [12] [13]:
- Upper endoscopy
- Esophageal manometry
- Twenty-four hour pH monitoring
Manometry measures intraesophageal pressures [6]. It is the primary method for identifying the causative mechanisms of gastroesophageal reflux disease [12].
Imaging studies [12]:
- Upper gastrointestinal contrast-enhanced studies
- Chest radiographic to assess pulmonary status and presence of hiatal hernia
Computed tomography scanning, magnetic resonance imaging, or ultrasonography are not usually needed [12]. When serious supraesophageal complications are suspected more invasive diagnostic studies may be needed. These include esophagogastroduodenoscopy, laryngoscopy, and esophageal biopsy [6].
X-Ray
- Esophageal Motility Disorder
Motility Disorders Deglutition Disorders Esophageal Diseases Gastrointestinal Diseases Digestive System Diseases Signs and Symptoms, Digestive Signs and Symptoms [clinicaltrials.gov]
Esophageal stricture or ulcer 4. Esophageal motility disorder on manometry 5. Barretts esophagus 6. Reflux esophagitisgrade D Los Angeles classification 7. Current pregnancy 8. [doi.org]
motility disorders.[14] It was found to be present in 22.3% of Canadians in one survey.[14] Diagnostic approach[edit] Heartburn can be caused by several conditions and a preliminary diagnosis of GERD is based on additional signs and symptoms. [en.wikipedia.org]
Available at http://www.giconsults.com/barretts-esophagus.cfm ] Differential Diagnosis Coronary artery disease Gallbladder disease Gastric or esophageal cancer Peptic ulcer disease Esophageal motility disorders Eosinophilic, infectious, or pill esophagitis [physio-pedia.com]
Colonoscopy
- Polyps
Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy. Aliment Pharmacol Ther 2006;24(9):1341-8. Bruley des Varannes S, Coron E, Galmiche JP. Short and long-term PPI treatment for GERD. [kjorl.org]
Yeomans, Systematic review with meta‐analysis: fundic gland polyps and proton pump inhibitors, Alimentary Pharmacology & Therapeutics, 44, 9, (915-925), (2016). Christopher M. Stark and Cade M. [dx.doi.org]
The gastric mucosa, however, is altered in these conditions (chronic gastritis, atrophy and polyps of fundic glands). [scielo.br]
Incidental gastric mucosal findings included: gastric erosions (N = 37), redness/submucosal hemorrhage (N = 5), gastric ulceration (N = 4), gastric nodularity/polyps (N = 2). [web.archive.org]
Treatment
Gastroesophageal reflux disease is treated by a progressive approach moving from lifestyle modification to control of gastric secretion by medication, and finally surgical treatment [1] [2]. Aggressive therapy with proton pump inhibitors, acid suppressive medications, is the recommended initial treatment[1].
The goals of treatment are to control symptoms, heal esophagitis, and prevent recurrent esophageal irritation and other complications. For optimum treatment of gastroesophageal reflux disease it is important to identify the underlying etiology responsible so that the most effective therapy can be initiated.
Lifestyle changes
Lifestyle changes have been proven to be effective in the treatment of gastroesophageal reflux disease [3]. Life modifications include the following [2] [8]:
- Weight loss, if overweight [7] [8]
- Avoidance of alcohol, coffee, chocolate, citrus juice, and tomatobased foods
- Small, frequent meals
- Wait 3 hours after a meal before lying down
- Refrain from eating within 3 hours of bedtime
- Elevate the head of the bed 8 inches [6]
- Avoid bending or stooping
Pharmacotherapy
The following medications are used in the management of gastroesophageal reflux disease [1] [10]:
- H2 receptor antagonists: Ranitidine, cimetidine, famotidine, nizatidine
- Proton pump inhibitors: Omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole
- Prokinetic agents: Aluminum hydroxide
- Antacids: Aluminum hydroxide, magnesium hydroxide
Protein pump inhibitors have become the primary intervention for the treatment of gastroesophageal reflux disease. It has proven to be cost-effective and generally safe [1]. A trial course of proton pump inhibitors may be used to help diagnosis the disorder [10]. Recent research has shown that long-term use of proton pump inhibitors may interfere with calcium absorption, but may also reduce bone reabsorption [10]. Standard-dosage of anti-reflux medications does not seem to reduce the incidence of cancer or Barrett’s esophagus [7].
Surgical intervention
Nissen fundoplication is an alternative therapy in patients who do not respond to medication. It involves wrapping the lower esophagus with muscles to increase the tone of the lower esophageal sphincter. However, as with any surgery this procedure may have significant complications [1]. Surgical repair of hiatal hernia is also an effective treatment for chronic gastroesophageal reflux disease [1].
Prognosis
Most patients with gastroesophageal reflux disease do well on medication therapy. Relapse after discontinuation of medication is common and indicates a need for long-term therapy [1] [7].
Surgical interventions, such as laparoscopic Nissen fundoplication may be necessary for patients with gastroesophageal reflux disease not responsive to medication or experiencing serious complications. It has been reported to be effective in approximately 92% of patients [1] [11].
Gastroesophageal reflux is usually benign in infants and very young children and responds to non-pharmacologic or conservative treatment [1].
Complications of chronic gastroesophageal reflux disease include erosive esophagitis, Barrett esophagus, and esophageal adenocarcinoma [2] [7].
Etiology
The etiology of gastroesophageal reflux disease is the excessive movement of gastric secretions, containing gastric acids and bile, from the duodenum and stomach into the esophagus [1] [4]. It is thought to be due to the relaxation of the lower esophageal sphincter or an imbalance in pressure surrounding this sphincter [3] [5].
Normal relaxation of the lower esophageal sphincter occurs with swallowing. Increased transient relaxation of this sphincter can be trigger by [3] [5]:
- Foods, such as coffee, alcohol, chocolate, fatty meals,
- Medications: beta-agonists, nitrates, calcium channel blockers, and anticholinergics
- Hormones: progesterone, estrogen
- Nicotine
In most adults the amount of gastric material refluxed into the esophagus is limited by normal defense mechanisms. These barriers minimize irritation to the esophageal mucosa and reduce symptoms [1]. Normal lower esophageal sphincter function and normal esophageal motility are the basis of these defensives [2].
While gastric reflux occurs in about 70% of adults in the general population, only 20% have symptoms of gastroesophageal reflux disease and erosion of the esophageal mucosa. Some recent studies hypothesize the influence of inherited mucosal resistance to be a factor [3].
Gastroesophageal reflux disease may cause other supra-esophageal symptoms such as laryngitis, asthma, cough, chest pain, and dental erosions [6] [7].
Epidemiology
Gastroesophageal reflux disease is most common in Western societies, probably due to dietary habits and the rate of obesity. The incidence in the United States is as high as 25 to 40% [3] [5]. Prevalence of gastroesophageal reflux disease worldwide ranges from 10 to 20% [8]. A large proportion of individual with gastroesophageal reflux disease are able to control symptoms with over-the-counter medications so the incidence is probably higher [10].
Obese individuals are almost three times more likely to suffer from gastroesophageal reflux disease with a prevalence of about 37% [8] [9].
The incidence is not influenced by race or gender. It occurs with equal frequency in men and women. However, severe symptoms such as Barrett esophagus are higher in men than women, perhaps 2 to 10 times as often [4] [8]. Gastroesophageal reflux disease occurs in all age groups but its prevalence increases in people over the age of 40 [8].
Pathophysiology
Gastroesophageal reflux disease results from the increased exposure of the esophagus to stomach contents causing mucosal damage and esophageal erosion [5]. The frequency of acid reflux is key to the development of gastroesophageal reflux disease. Reflux occurs most often during the normal lower esophageal sphincter relaxations that follow swallowing [11] [12] [13].
The etiology of gastroesophageal reflux disease is multifactorial with the primary factors [2] [5] [13]:
- Increased intraabdominal pressure
- Impaired gastric emptying
- Decreased lower esophageal sphincter pressure
- Increased frequency of transient sphincter relaxation
- Gastric distention
- Impaired esophageal or gastric clearance
The lower esophageal sphincter, located in the abdomen, is assisted by the diaphragmatic crura, tendon-like attachments, to prevent reflux [11]. When the lower esophageal sphincter migrates into the chest due to the presence of a hiatal hernia this function is lost [12] [13].
Decreased esophageal clearance is a result of poor esophageal motility [12] [13]. Esophageal acid clearance time is the amount of time it takes the esophagus to return to a neutral pH level after acidic reflux [13]. Acid clearance time and esophageal motor function combine to affect the amount of mucosa irritation [13].
Delayed gastric emptying may also be a factor, as it increases the volume and pressure in the stomach until the balance of pressure against the lower esophageal sphincter is disturbed leading to reflux [3] [11].
Esophageal mucosal resistance is a protective mechanism that varies from individual to individual. Some have suggested that this factor has a hereditary basis [3] [11].
Studies have shown that gastroesophageal reflux disease is much more prevalent in obese individuals and that a high body mass index (BMI) is a risk factor for the development of this disorder. The exact reason for this is not fully known. It is thought that hiatal hernia occurs more frequently and intraabdominal pressure increases with obesity [2] [9].
Complications of gastroesophageal reflux disease are usually associated with supraesophageal or upper airway exposure to gastric acid from microaspiration and triggering of the vasovagal reflex [4].
These complications include [2]:
- Chronic cough
- Asthma
- Laryngitis
- Pneumonia
- Esophagitis
- Barrett esophagus
- Esophageal adenocarcinoma
Prevention
The most effective method of preventing gastroesophageal reflux disease and its complications is through the appropriate lifestyle changes [6]. Weight reduction to normal is probably the single most effective single intervention for prevention [8].
Taking antacids immediately after an episode of heartburn may help decrease esophageal exposure time and prevent esophageal damage and complications of gastroesophageal reflux disease [6].
Rinsing with neutral pH mouthwashes, applying fluoride gels and avoiding brushing teeth immediately after reflux episodes may help to prevent dental erosion [6].
Summary
Gastroesophageal reflux disease results from the reflux of gastric contents into the esophagus causing symptoms of heartburn, regurgitation, and dysphagia [1] [2]. It is associated with esophagitis, laryngitis, and dental erosion. Other symptoms may accompany this disease including non-cardiac chest pain, asthma, pneumonia, hoarseness, and aspiration [2].
Reflux of small amounts of stomach contents into the esophagus is a normal physiologic occurrence experienced by most people intermittently. Gastroesophageal reflux disease (GERD) occurs when this process is abnormal and excessive amounts of gastric acid or mucosal exposure time are extended [1] [2].
Gastroesophageal reflux disease is estimated to occur in 25-40% of healthy American adults [3]. At least, 7-10% of these people experiences symptoms on a daily basis [2].
Complications of gastroesophageal reflux disease include chronic painful esophagitis, appetite disturbances, dental erosion, asthma, and potentially esophageal cancer [3] [4].
Patient Information
What is gastroesophageal reflux disease?
Gastroesophageal reflux disease refers to symptoms resulting from an abnormal backflow of stomach contents into the esophagus. This fluid contains gastric acids and bile. Both of these substances cause irritation, inflammation, and erosion of the mucosa of the esophagus.
What are the symptoms?
The typical symptoms of gastroesophageal reflux disease include:
- Heartburn
- Regurgitation
- Dysphagia
Other less frequent symptoms of this disorder are:
- Coughing or wheezing
- Throat clearing
- Aspiration pneumonia
- Bronchitis
- Hoarseness, sore throat
- Ear pain
- Non-cardiac chest pain
- Enamel erosion or other dental problems
What causes gastroesophageal reflux disease?
The cause of gastroesophageal reflux disease is the abnormal backflow of gastric acid into the esophagus. The reasons for this are multiple and are different for each patient. Factors that influence reflux include:
- Lifestyle: Diet, alcohol, caffeine, obesity
- Structural abnormalities: Hiatal hernia
- Mechanical abnormalities: Poor lower esophageal sphincter function, decreased esophageal motility
Who gets gastroesophageal reflux disease?
Approximately 10 to 20% of the adults in the United States suffer from gastroesophageal reflux disease. It occurs at all ages, equally in men and women and in all races and ethnic groups. Obese individuals are at higher risk of this disorder as it occurs three times more often in those who are overweight. Gastroesophageal reflux disease occurs most frequently in Western societies probably due to diet and the prevalence of obesity.
How is gastroesophageal reflux disease diagnosed?
Gastroesophageal reflux disease is generally suspected on the basis of patient history and symptoms. Two procedures are useful in diagnosing the disorder: monitoring of the pH, acid concentration, in the esophagus and manometry, that measures the functioning of the lower esophageal sphincter.
Today diagnosis is often made by a non-invasive means with a trial of anti-reflux medication. A relief of symptoms with medication confirms the diagnosis.
How is gastroesophageal reflux disease treated?
Gastroesophageal reflux disease may be treated in three ways:
- Lifestyle changes: Avoiding high acid foods, citrus, fatty foods, chocolate, alcohol, caffeine, and nicotine
- Medications: Antacids, anti-reflux medications, and acid suppressors
- Surgery to repair esophageal sphincter abnormalities and hiatal hernia
What are the complications?
There are many possible complications of gastroesophageal reflux disease. They include:
- Chronic cough
- Asthma
- Laryngitis, hoarse voice
- Erosion of tooth enamel
- Pneumonia
- A severe form of esophagitis called Barrett esophagus
- Esophageal cancers
How can gastroesophageal reflux disease be prevented?
Prevention of gastroesophageal reflux disease depends upon the underlying cause of the disorder. The most effective method of preventing gastroesophageal reflux disease and its complications is through the appropriate lifestyle changes. Weight reduction to normal is probably the single most effective intervention for prevention. Taking antacids immediately after an episode of heartburn may help decrease esophageal damage. Rinsing with neutral pH mouthwashes, applying fluoride gels and avoiding brushing teeth immediately after reflux episodes may help to prevent dental erosion.
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