Gastroesophageal reflux disease (GERD) is a common condition in which the gastric contents move up into the esophagus. Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.
Gastroesophageal Reflux Disease (GERD) Gastroesophageal reflux disease (GERD) is a common condition in which the gastric contents move up into the esophagus. Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.
However, medically refractory GERD is becoming increasingly common, requiring a tailored approach in the management of GERD. Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder characterized by the regurgitation of gastric contents into the esophagus.
Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract. The main symptom of GERD is heartburn, often described as a fiery feeling in one's chest, and regurgitating sour or bitter liquid to the throat or mouth.
Causes. GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach.. When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach.
Gastroesophageal reflux disease (GERD) is long-term, regular acid reflux. This can cause heartburn and tissue damage. Medication and surgery can treat it.
There are four approaches for gastroesophageal reflux disease (GERD) treatment, including medication and surgery. Often, patients respond well to a combination of lifestyle changes and a medication regimen.
Clinical trials. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.. Lifestyle and home remedies. Lifestyle changes may help reduce the frequency of acid reflux. Try to: Maintain a healthy weight.
Gastroesophageal reflux disease (GERD) is a common condition in which the gastric contents move up into the esophagus. Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.
A diagnosis of GERD starts with a thorough physical examination, during which you describe your symptoms and medical history. If the typical symptoms of reflux disease are present, including heartburn and regurgitation, your doctor may begin treatment without performing specific diagnostic tests.
A barium esophagram also evaluates the coordination of your esophageal motor function. While it does not test for the presence of reflux, it is useful for evaluating injury to your esophagus.
It can also help diagnose an esophageal stricture (narrowing). Although only 10 percent to 20 percent of people with reflux will have abnormal findings during an endoscopy, the procedure is necessary to evaluate the potential for complications.
Upper Endoscopy. Upper endoscopy allows your doctor to examine the lining of your esophagus, stomach and first part of the small intestine. It is the best test for evaluating reflux-induced esophageal injury and diagnosing esophagitis and Barrett's esophagus. It can also help diagnose an esophageal stricture (narrowing).
Your doctor performs an endoscopy and places a small chip in your lower esophagus. The chip records the acid level in your esophagus for 48 hours. The chip transmits your acid level to a wireless recording device that you wear around your belt. The data from the recording device can gauge your reflux severity.
Other symptoms of GERD include: Non-burning chest pain, which is usually located in the middle of the chest and radiates to the back. Difficulty swallowing (dysphagia) Atypical reflux symptoms relating to the throat, larynx or lungs: Sore throat. Coughing.
Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder characterized by the regurgitation of gastric contents into the esophagus. It is one of the most commonly diagnosed digestive disorders in the US with a prevalence of 20%, resulting in a significant economic burden in direct and indirect costs and adversely affects the quality of life[1][2]. GERD is caused by multiple different mechanisms that can be intrinsic, structural, or both, leading to the disruption of the esophagogastric junction barrier resulting in exposure of the esophagus to acidic gastric contents. Clinically, GERD typically manifests with symptoms of heartburn and regurgitation. It can also present in an atypical fashion with extra-esophageal symptoms such as chest pain, dental erosions, chronic cough, laryngitis, or asthma[3][4]. Based on endoscopic and histopathologic appearance, GERD is classified into three different phenotypes: non-erosive reflux disease (NERD), erosive esophagitis (EE), and Barrett esophagus (BE)[5]. NERD is the most prevalent phenotype seen in 60-70% of patients followed by erosive esophagitis and BE seen in 30% and 6-12% of patients with GERD, respectively. [1][5][6]. Over the years, the mainstay in the management of GERD has been lifestyle modifications, and proton pump inhibitors (PPIs). However, medically refractory GERD is becoming increasingly common, requiring a tailored approach in the management of GERD.
Individuals should also be counseled about avoiding meals at least 3 hours before bedtime and maintaining good sleep hygiene as it has been shown that minimal disturbances in sleep are associated with suppression of TLESRs, resulting in decreased reflux episodes[27][33]. Studies have also shown improvement in GERD symptoms and pH monitoring studies with the elevation of the head end of the bed. Diet modification with the elimination of chocolate, caffeine, and spicy foods, citrus, and carbonated beverages in GERD is controversial and is not routinely recommended as per current ACG guidelines[29].
The esophageal mucosa comprises various structural and functional constituents that function as a protective defense barrier against the luminal substances encountered with GERD [18]. This defensive barrier can be breached by prolonged exposure to the refluxate, which consists of both acidic gastric contents (hydrochloric acid and pepsin) and alkaline duodenal contents (bile salts and pancreatic enzymes) leading to mucosal damage. The influence of gastroparesis on GERD is unknown. It is believed that delayed gastric emptying contributes to GERD symptoms due to gastric distention and increased exposure to the gastric refluxate[18].
The esophageal squamous epithelium serves to function as a protective defense barrier against the retrograde migration of refluxate. Disruption of this epithelial defense is a common phenomenon in GERD and NERD [25]. The histopathological features of GERD are not unique to this condition due to minimal biopsy criteria for diagnosis and varying sensitivity and specificity in the diagnosis[26].In fact, the histopathologic diagnosis of GERD is made based on an array of microscopic findings that include features of inflammation, basal cell hyperplasia, papilla elongation, and dilatation of intercellular spaces[26].
A systematic review by El-Serag et al. estimated the prevalence of GERD in the US between 18.1% to 27.8%. However, the true prevalence of this disorder could be higher because more individuals have access to over-the-counter acid, reducing medications[2][13][2]. The prevalence of GERD is slightly higher in men compared to women[14]. A large meta-analysis study by Eusebi et al. estimated the pooled prevalence of GERD symptoms to be marginally higher in women compared with men (16.7% (95% CI 14.9% to 18.6%) vs. 15.4% (95% CI 13.5% to 17.4%)[12]. Women presenting with GERD symptoms are more likely to have NERD than men who are more likely to have erosive esophagitis[15]. However, men with longstanding symptoms of GERD have a higher incidence of Barrett's esophagus (23%) compared to women (14%)[16].
The typical clinical presentation of GERD is heartburn and regurgitation. However, GERD can also present with various other symptoms that include dysphagia, odynophagia, belching, epigastric pain, and nausea [27]. Heartburn is defined as a retrosternal burning sensation or discomfort that may radiate into the neck and typically occurs after the ingestion of meals or when in a reclined position[28]. Regurgitation is a retrograde migration of acidic gastric contents into the mouth or hypopharynx[28]. GERD presentation is considered to be atypical when patients present with extraesophageal symptoms such as chest pain, chronic cough, asthma, laryngitis, dental erosions, dysphonia, and hoarseness, and globus sensation[3][4].
The pathophysiology of GERD is multifactorial and is best explained by various mechanisms involved, including the influence of the tone of the lower esophageal sphincter, the presence of a hiatal hernia, esophageal mucosal defense against the refluxate and esophageal motility.
Gastroesophageal reflux disease (GERD) is a common condition in which the gastric contents move up into the esophagus. Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.
A diagnosis of GERD starts with a thorough physical examination, during which you describe your symptoms and medical history. If the typical symptoms of reflux disease are present, including heartburn and regurgitation, your doctor may begin treatment without performing specific diagnostic tests.
A barium esophagram also evaluates the coordination of your esophageal motor function. While it does not test for the presence of reflux, it is useful for evaluating injury to your esophagus.
It can also help diagnose an esophageal stricture (narrowing). Although only 10 percent to 20 percent of people with reflux will have abnormal findings during an endoscopy, the procedure is necessary to evaluate the potential for complications.
Upper Endoscopy. Upper endoscopy allows your doctor to examine the lining of your esophagus, stomach and first part of the small intestine. It is the best test for evaluating reflux-induced esophageal injury and diagnosing esophagitis and Barrett's esophagus. It can also help diagnose an esophageal stricture (narrowing).
Your doctor performs an endoscopy and places a small chip in your lower esophagus. The chip records the acid level in your esophagus for 48 hours. The chip transmits your acid level to a wireless recording device that you wear around your belt. The data from the recording device can gauge your reflux severity.
Other symptoms of GERD include: Non-burning chest pain, which is usually located in the middle of the chest and radiates to the back. Difficulty swallowing (dysphagia) Atypical reflux symptoms relating to the throat, larynx or lungs: Sore throat. Coughing.