GERD

Definition: A condition in which there are troublesome symptoms and/or

complications secondary to retrograde flow of gastric contents into the
esophagus, oropharynx, and/or respiratory tract.
Causes: There’s impairment of the antireflux barrier which is created by a
combination of the normal anatomical configuration of the esophagogastric
junction (EG) and the strength and function of the lower esophageal sphincter
(LES). It most often occurs when LES pressure (measured manometrically) is
low or the normal angulation of the EG junction is lost (as occurs when a hiatus
hernia is present.)

Manifestations:
Typical manifestations:
Symptoms:
Heartburn (daytime or night-time)
Regurgitation (daytime or nighttime)
Water brash (hypersalivation)
Complications:
Esophagitis
Esophageal strictures
Barret’s esophagus
Atypical (extraesophageal) manifestations:
Pulmonary Pharyngo-laryngeal
Asthma Pharyngitis
Aspiration pneumonia Vocal cord granulomas
Chronic bronchitis Subglottic stenosis
Bronchiectasis Laryngitis
Interstitial pulmonary fibrosis Stridor
Oral Hoarseness
Halitosis Globus
Dental caries Laryngeal cancer
Poor oral hygiene Chronic cough
Diagnosis: In the presence of typical symptoms, especially frequent heartburn
and regurgitation, reflux treatment can be initiated without specific diagnostic
testing. Objective testing is required only when the patient presents with
atypical symptoms.
1. pH probes and impedance monitoring
2. Esophageal manometry
3. Imaging studies such as barium contrast radiography
4. Empiric medical therapy (PPI and observing for symptom development)
5. Upper endoscopy
Treatment:
Lifestyle modifications: head elevation, avoid certain foods (spicy or fatty
foods, caffeine, carbonated drinks), weight loss, smoking cessation and alcohol
minimization, avoid medications that decrease lower esophageal pressure or
irritate the esophagus, and avoid tight closing around the waist.
Pharmacologic therapy: histamine-2 (H2) receptor antagonists, proton pump
inhibitors (PPI), and prokinetic agents.
Surgical therapy: reduction of the hiatal hernia, repair of the diaphragmatic
hiatus, strengthening the attachment between the EG junction and the posterior
diaphragm, and strengthening the anti-reflux barrier by adding a gastric wrap
around the gastroesophageal junction (fundoplication.)