Gastroesophageal reflux disease: Difference between revisions
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==Background== | ==Background== | ||
*Abbreviation: GERD | |||
*Affects up to 20% of population | *Affects up to 20% of population | ||
*Assume chest pain is cardiac origin until proven otherwise | *Assume [[chest pain]] is cardiac origin until proven otherwise | ||
===Causes=== | ===Causes=== | ||
*Decreased pressure of lower esophageal sphincter | *Decreased pressure of lower esophageal sphincter | ||
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**Nicotine | **Nicotine | ||
**[[Ethanol]] | **[[Ethanol]] | ||
**Caffeine | **[[Caffeine]] | ||
** | **Medications (mintrates, [[calcium-channel blockers]], [[anticholinergics]], progesterone/estrogen) | ||
**Pregnancy | **[[Pregnancy]] | ||
*Decreased esophageal motility | *Decreased esophageal motility | ||
**Achalasia | **[[Achalasia]] | ||
**Scleroderma | **[[Scleroderma]] | ||
**[[Diabetes]] | **[[Diabetes]] | ||
*Prolonged gastric emptying | *Prolonged gastric emptying | ||
**Anticholinergics | **[[Anticholinergics]] | ||
**Outlet obstruction | **Outlet obstruction | ||
**Diabetic gastroparesis | **Diabetic [[gastroparesis]] | ||
*High-fat food | *High-fat food | ||
== | ==Clinical Features== | ||
*Pain and discomfort with meals | ===Typical=== | ||
*[[epigastric pain|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]]: | *[[Chest pain]] with features similar to [[ACS]]: | ||
**Exertional, associated with diaphoresis, nausea/[[vomiting]], radiating to arm | **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 (peds)|Failure to thrive]]/weight loss | |||
**[[Esophagitis]] | |||
**Respiratory disease: refractory [[asthma]], recurrent [[pneumonia]], apnea | |||
**[[BRUE]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
*Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods) | |||
*Sleep with head of bed elevated | |||
*Avoid eating within 3hr of sleep | |||
*[[PPI]] or [[H2 blocker]] | |||
===Infants=== | |||
*Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds | |||
**medications only if significant complications | |||
==Disposition== | ==Disposition== | ||
Revision as of 20:51, 29 September 2019
Background
- Abbreviation: GERD
- 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
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 or H2 blocker
Infants
- Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds
- medications only if significant complications
Disposition
- Home (outpatient treatment)