Gastroesophageal reflux disease

Background

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

Causes

Clinical Features

Typical

  • Pain and discomfort with or right after meals
    • typically described as burning pain
    • often worse when lying flat
    • dysphagia

Atypical

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

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)

See Also

References

Authors:

Ross Donaldson