Gastroesophageal reflux disease: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | [[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | ||
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | [[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | ||
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**Usually accompanied by "heartburn" symptoms and histopathologic changes in the esophagus | **Usually accompanied by "heartburn" symptoms and histopathologic changes in the esophagus | ||
*Affects up to 20% of population | *Affects up to 20% of population | ||
*Assume [[chest pain]] is cardiac origin until proven otherwise | *Assume [[Special:MyLanguage/chest pain|chest pain]] is cardiac origin until proven otherwise | ||
===Causes=== | ===Causes=== | ||
*Decreased pressure of lower esophageal sphincter | *Decreased pressure of lower esophageal sphincter | ||
**High-fat food | **High-fat food | ||
**Nicotine | **Nicotine | ||
**[[Ethanol]] | **[[Special:MyLanguage/Ethanol|Ethanol]] | ||
**[[Caffeine]] | **[[Special:MyLanguage/Caffeine|Caffeine]] | ||
**Medications (mintrates, [[calcium-channel blockers]], [[anticholinergics]], progesterone/estrogen) | **Medications (mintrates, [[Special:MyLanguage/calcium-channel blockers|calcium-channel blockers]], [[Special:MyLanguage/anticholinergics|anticholinergics]], progesterone/estrogen) | ||
**[[Pregnancy]] | **[[Special:MyLanguage/Pregnancy|Pregnancy]] | ||
*Decreased esophageal motility | *Decreased esophageal motility | ||
**[[Achalasia]] | **[[Special:MyLanguage/Achalasia|Achalasia]] | ||
**[[Scleroderma]] | **[[Special:MyLanguage/Scleroderma|Scleroderma]] | ||
**[[Diabetes]] | **[[Special:MyLanguage/Diabetes|Diabetes]] | ||
*Prolonged gastric emptying | *Prolonged gastric emptying | ||
**[[Anticholinergics]] | **[[Special:MyLanguage/Anticholinergics|Anticholinergics]] | ||
**Outlet obstruction | **Outlet obstruction | ||
**Diabetic [[gastroparesis]] | **Diabetic [[Special:MyLanguage/gastroparesis|gastroparesis]] | ||
*High-fat food | *High-fat food | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:GERD 2.png|thumb|Severe tooth erosion in GERD<ref>Ranjitkar S, Kaidonis JA, Smales RJ (2012). "Gastroesophageal Reflux Disease and Tooth Erosion". International Journal of Dentistry. 2012: 479850. doi:10.1155/2012/479850. ISSN 1687-8728. PMC 3238367. PMID 22194748.</ref>]] | [[File:GERD 2.png|thumb|Severe tooth erosion in GERD<ref>Ranjitkar S, Kaidonis JA, Smales RJ (2012). "Gastroesophageal Reflux Disease and Tooth Erosion". International Journal of Dentistry. 2012: 479850. doi:10.1155/2012/479850. ISSN 1687-8728. PMC 3238367. PMID 22194748.</ref>]] | ||
===Typical=== | ===Typical=== | ||
*[[epigastric pain|Pain]] and discomfort with or right after meals | |||
*[[Special:MyLanguage/epigastric pain|Pain]] and discomfort with or right after meals | |||
**typically described as burning pain | **typically described as burning pain | ||
**often worse when lying flat | **often worse when lying flat | ||
*+/-[[Dysphagia]] | *+/-[[Special:MyLanguage/Dysphagia|Dysphagia]] | ||
===Atypical=== | ===Atypical=== | ||
*[[Chest pain]] with features similar to [[ACS]]: | |||
**Exertional, associated with diaphoresis, nausea/[[vomiting]], radiating to arm | *[[Special:MyLanguage/Chest pain|Chest pain]] with features similar to [[Special:MyLanguage/ACS|ACS]]: | ||
*[[Asthma]] | **Exertional, associated with diaphoresis, nausea/[[Special:MyLanguage/vomiting|vomiting]], radiating to arm | ||
*[[Pneumonia]] | *[[Special:MyLanguage/Asthma|Asthma]] | ||
*[[Special:MyLanguage/Pneumonia|Pneumonia]] | |||
*Hoarseness | *Hoarseness | ||
*Aspiration | *Aspiration | ||
===Pediatric=== | ===Pediatric=== | ||
*Reflux is physiologic in infants | *Reflux is physiologic in infants | ||
*Pathologic only if it causes complications, such as: | *Pathologic only if it causes complications, such as: | ||
**[[Failure to thrive (peds)|Failure to thrive]]/weight loss | **[[Special:MyLanguage/Failure to thrive (peds)|Failure to thrive]]/weight loss | ||
**[[Esophagitis]] | **[[Special:MyLanguage/Esophagitis|Esophagitis]] | ||
**Respiratory disease: refractory [[asthma]], recurrent [[pneumonia]], apnea | **Respiratory disease: refractory [[Special:MyLanguage/asthma|asthma]], recurrent [[Special:MyLanguage/pneumonia|pneumonia]], apnea | ||
**[[BRUE]] | **[[Special:MyLanguage/BRUE|BRUE]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Abdominal Pain DDX Epigastric}} | {{Abdominal Pain DDX Epigastric}} | ||
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==Management== | ==Management== | ||
[[File:Peptic stricture.png|thumb|Endoscopic image showing narrowing of the esophagus near the junction with the stomach, a complication of chronic gastroesophageal reflux disease that can cause dysphagia.]] | [[File:Peptic stricture.png|thumb|Endoscopic image showing narrowing of the esophagus near the junction with the stomach, a complication of chronic gastroesophageal reflux disease that can cause dysphagia.]] | ||
*Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods) | *Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods) | ||
*Sleep with head of bed elevated | *Sleep with head of bed elevated | ||
*Avoid eating within 3hr of sleep | *Avoid eating within 3hr of sleep | ||
*[[PPI]], [[H2 blocker]], [[bismuth subsalicylate]] | *[[Special:MyLanguage/PPI|PPI]], [[Special:MyLanguage/H2 blocker|H2 blocker]], [[Special:MyLanguage/bismuth subsalicylate|bismuth subsalicylate]] | ||
===Infants=== | ===Infants=== | ||
*Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds | *Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds | ||
**medications only if significant complications | **medications only if significant complications | ||
==Disposition== | ==Disposition== | ||
*Home (outpatient treatment) | *Home (outpatient treatment) | ||
==See Also== | ==See Also== | ||
*[[Abdominal Pain]] | |||
*[[Special:MyLanguage/Abdominal Pain|Abdominal Pain]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
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Latest revision as of 22:56, 4 January 2026
Background
- Abbreviation: GERD
- Definition: a highly variable chronic condition that is characterized by periodic episodes of backward flow of the gastric contents into the esophagus due to improper functioning of a sphincter at the lower end of the esophagus
- Usually accompanied by "heartburn" symptoms and histopathologic changes in the esophagus
- Affects up to 20% of population
- Assume chest pain is cardiac origin until proven otherwise
Causes
- Decreased pressure of lower esophageal sphincter
- High-fat food
- Nicotine
- Ethanol
- Caffeine
- Medications (mintrates, calcium-channel blockers, anticholinergics, progesterone/estrogen)
- Pregnancy
- Decreased esophageal motility
- Prolonged gastric emptying
- Anticholinergics
- Outlet obstruction
- Diabetic gastroparesis
- High-fat food
Clinical Features
Severe tooth erosion in GERD[1]
Typical
- Pain and discomfort with or right after meals
- typically described as burning pain
- often worse when lying flat
- +/-Dysphagia
Atypical
- Chest pain with features similar to ACS:
- Exertional, associated with diaphoresis, nausea/vomiting, radiating to arm
- Asthma
- Pneumonia
- Hoarseness
- Aspiration
Pediatric
- Reflux is physiologic in infants
- Pathologic only if it causes complications, such as:
- Failure to thrive/weight loss
- Esophagitis
- Respiratory disease: refractory asthma, recurrent pneumonia, apnea
- BRUE
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
Management
- Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
- Sleep with head of bed elevated
- Avoid eating within 3hr of sleep
- PPI, H2 blocker, bismuth subsalicylate
Infants
- Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds
- medications only if significant complications
Disposition
- Home (outpatient treatment)
See Also
References
- ↑ Ranjitkar S, Kaidonis JA, Smales RJ (2012). "Gastroesophageal Reflux Disease and Tooth Erosion". International Journal of Dentistry. 2012: 479850. doi:10.1155/2012/479850. ISSN 1687-8728. PMC 3238367. PMID 22194748.