Gastroesophageal reflux disease

From IKE

Gastroesophageal reflux disease (aka GERD) is the most common cause of esophagitis. It is due to esophageal injury secondary to the reflux of gastric contents into the esophagus. A hiatal hernia predisposes toward reflux, as does any factor that decreases the tone of the lower esophageal sphincter (LES), such as ingestion of alcohol and fatty foods, cigarette smoke, pregnancy, or the presence of a nasogastric tube. The refluxate damages the squamous epithelium because it contains acid and pepsin, with or without bile.

Symptoms include heartburn and dyspepsia. Prolonged reflux may lead to a variety of complications, including hematemesis due to ulceration and dysphagia due to stricture formation from fibrosis and wall thickening.

Reflux potential is indicated by a positive barium x-ray, which may indicate a hiatal hernia, or by esophageal manometry that may reveal an incompetent lower esophageal sphinter (LES). Esophageal damage may be tested for with an acid perfusion (Bernstein) test, endoscopy, mucosal biopsy, or barium x-ray. Usually, however, diagnosis and assessment of the damage happens clinically.

The most important long-term consequence of gastroesophageal reflux disease is the development of Barrett's esophagus (BE).

Management

There are several phases of management of gastroesophageal reflux disease depending on the severity of the condition and the success of previous therapeutic attempts. The first phase is as simple as dietary modification, slanting the patient's bed (e.g., raising the head by six inches), and discontinuing irritants such as tobacco smoke and harmful medications. The next phase involves pharmaceutical medical management, and the final stage is invasive surgical intervention.