JAMA PATIENT PAGE

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is a common condition in which stomach contents
back up into the esophagus, causing uncomfortable symptoms.
The esophagus is the muscular tube connecting the mouth to the
Gastroesophageal reflux disease (GERD) is a common condition that
stomach. In the stomach, acid is produced to help digest food. If acidic occurs when acidic stomach contents enter the esophagus, causing symptoms
stomach content reaches the esophagus, it can cause long- such as heartburn and regurgitation. GERD can cause inflammation of the
esophageal mucosa and slightly increases risk of esophageal cancer.
standing and troublesome symptoms or specific complications,
known as gastroesophageal reflux disease (GERD). GERD is one A healthy esophageal sphincter functions as a valve to keep
stomach contents from backing up into the esophagus.
of the most common diseases, and it is estimated that approxi- Esophagus
mately 20% of the adult population in the Western world experi-
Diaphragm
ences GERD.
Esophageal
sphincter STOMACH
Causes of GERD Esophagus
Patients with GERD have an ineffective valve mechanism between
the esophagus and stomach (lower esophageal sphincter), which Diaphragm
otherwise prevents stomach contents from backing up into the When valve function is reduced,
esophagus. GERD occurs more frequently if a part of the stomach stomach acid can enter the
Stomach esophagus and cause GERD.
is pushed up into the thoracic cavity, a condition called a hiatal
hernia. Risk factors for developing GERD are obesity, tobacco smok-
ing, and heredity. Esophagus

GERD occurs frequently in the presence Esophageal

of hiatal hernia, when part of the stomach sphincter
Symptoms
moves upward through the diaphragm, Hiatal hernia
The most common symptoms of GERD are burning sensations causing a reduction in valve function.
behind the breastbone (heartburn) or the sensation of regurgita-
tion of stomach contents into the upper throat (acid regurgitation). STOMACH

In individuals with typical symptoms, treatment is often prescribed Treatment of GERD

without further examination. Long-standing GERD can lead to
inflammation of the esophagus and can also lead to cell changes in
the esophagus that slightly increase the risk of developing esopha-
geal cancer.
GERD is treated with proton pump inhibitor drugs that reduce the production of
stomach acid and lifestyle changes such as losing weight and smoking cessation.
Some patients may also be considered for a surgical procedure called
fundoplication that reinforces the esophageal sphincter.

Treatment During fundoplication,

Doctors may advise patients with symptoms of GERD to make life- the upper part of the stomach
is wrapped around the lower
style changes, such as lose weight and stop smoking. The first-line part of the esophagus.
medical treatment for GERD is a proton pump inhibitor (PPI), such The additional resistance
prevents stomach
as omeprazole or esomeprazole. Proton pump inhibitors inhibit content backup.
production of acid in the cells of the stomach wall, thereby reduc-
ing the acidic contents and the symptoms of GERD. Most patients
who have symptoms of GERD are prescribed a PPI trial, in which
FOR MORE INFORMATION
they take a PPI daily for a couple of weeks, and if their symptoms
National Institute of Diabetes and Digestive and Kidney Diseases
clearly diminish, it provides evidence for a diagnosis of GERD. www.niddk.nih.gov/health-information/digestive-diseases/acid-
In some patients, especially young and otherwise healthy people, reflux-ger-gerd-adults
a surgical procedure known as fundoplication can be considered.
During a fundoplication, the upper part of the stomach is wrapped To find this and other JAMA Patient Pages, go to the Patient
around the lower esophagus, thereby mechanically and physiologi- Information collection at jamanetworkpatientpages.com.
cally preventing GERD.

Authors: John Maret-Ouda, MD, PhD; Sheraz R. Markar, MD, PhD; Jesper Lagergren,
MD, PhD
Author Affiliations: Upper Gastrointestinal Surgery, Department of Molecular
Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital,
Stockholm, Sweden.
Conflict of Interest Disclosures: None reported.
Source: Maret-Ouda J, Markar SR, Lagergren J. Gastroesophageal reflux disease:
a review. JAMA. Published December 22, 2020. doi:10.1001/jama.2020.21360
The JAMA Patient Page is a public service of JAMA. The information and
recommendations appearing on this page are appropriate in most instances, but they
are not a substitute for medical diagnosis. For specific information concerning your
personal medical condition, JAMA suggests that you consult your physician. This page
may be photocopied noncommercially by physicians and other health care
professionals to share with patients. To purchase bulk reprints, email reprints@
jamanetwork.com.

jama.com (Reprinted) JAMA December 22/29, 2020 Volume 324, Number 24 2565

© 2020 American Medical Association. All rights reserved.

Downloaded From: https://jamanetwork.com/ Mexico | Access Provided by JAMA by Alberto Carranza on 02/22/2022