Gastroesophageal reflux disease

Background

• Affects up to 20% of population
• Assume chest pain is cardiac origin until proven otherwise
• Causes

1. Decreased pressure of lower esophageal sphincter
   1. High-fat food
   2. Nicotine
   3. Ethanol
   4. Caffeien
   5. Meds (mintrates, CCBs, anticholinergics, progesterone/estrogen)
   6. Pregnancy
2. Decreased esophageal motility
   1. Achalasia
   2. Scleroderma
   3. Diabetes
3. Prolonged gastric emptying
   1. Anticholinergics
   2. Outlet obstruction
   3. Diabetic gastroparesis
4. High-fat food

Diagnosis

• Pain and discomfort w/ meals
• Chest pain w/ features similar to ACS:
  • Exertional, a/w diaphoresis, N/V, radiating to arm

Treatment

1. Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
2. Sleep w/ head of bed elevated
3. Avoid eating w/in 3hr of sleep
4. PPI or H2 blocker

See Also

• Abdominal Pain

Source

Tintinalli