GI Conditions
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      2. GI Conditions

      Gastroesophageal Reflux Disease

      Brief Overview: According to NIDDK, “Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus. Many people have GER occasionally, and GER often happens without causing symptoms. Gastroesophageal reflux disease (GERD) is a more severe and long-lasting condition in which GER causes repeated symptoms that are bothersome or leads to complications over time.”

      Prevalence: The prevalence of GERD is estimated to be 15-30% in Western countries.

      Etiology: GERD develops when your lower esophageal sphincter becomes weak or relaxes when it shouldn’t. When this happens, the lower esophageal sphincter allows acid/stomach contents to pass back up into the esophagus.

      Risk Factors:

      • Obesity
      • Pregnancy
      • Estrogen replacement therapy in postmenopausal women
      • Specific diet and medications
      • Stress, sleep deprivation
      • Hiatal hernia
      • Tobacco use

      Commonly Associated Conditions:

      • Hiatal hernia
      • Barrett’s esophagus
      • Obesity
      • Scleroderma
      • Asthma
      • Esophagitis

      Common Medications:

      • Proton Pump Inhibitors (PPIs) – omeprazole, lansoprazole, pantoprazole, esomeprazole
      • Antacids – Maalox, Tums, Mylanta
      • Histamine blockers – Pepcid, Tagamet

      Common Labs, Imaging, and Tests:

      • The diagnosis is typically made based on symptoms, but an upper endoscopy with biopsy, prolonged esophageal pH study, or esophageal manometry may be indicated for some patients

      Common Symptoms:

      • Heartburn
      • Regurgitation
      • Dysphagia – difficulty swallowing
      • GERD-related chest pain
      • Globus sensation – feeling like there is a lump in the throat
      • Chronic cough, hoarseness, wheezing, sore throat

      Common Treatments:

      • Medications (see above)
      • Lifestyle changes
        • Weight loss if indicated
        • Raising the head of the bed 6-8 inches
        • Wait 3 hours after eating before going to bed
        • Sleep on left side
        • Avoid triggering foods
        • Smoking cessation
        • Wear loose, comfortable clothing

      Physical Findings:

      • Typically, normal physical exam
      • Possible dental enamel erosion
      • Epigastric tenderness may be present

      Potential Complications and Contraindications:

      • Erosive esophagitis
      • Esophageal stricture
      • Barrett’s Esophagus
      • Pneumonia
      • Asthma symptoms or asthma exacerbations
      • Permanent lung damage
      • Dental problems – enamel erosion

      General Health and Lifestyle Guidance:

      • Keep a food/symptom log to identify any trigger foods
      • Eat smaller, more frequent meals
      • Generally, it is recommended to avoid: acidic foods (citrus, tomatoes), alcohol, chocolate, coffee, caffeine, high-fat foods, peppermint, spicy foods
      • You can elevate the head of your bed by putting wood blocks under the legs or adding a foam wedge over the mattress. You may be able to buy a commercial product for this purpose
      • Smoking cessation
      • See lifestyle changes listed above

      Suggested Questions to Ask Patients:

      • How often do you experience heartburn or regurgitation?
      • Do symptoms worsen after meals or at night?
      • Are you currently using any over-the-counter or prescription medications for reflux?
      • Have you had difficulty swallowing or unexplained weight loss?
      • Do you wake up with coughing, choking, or sore throat?

      Suggested Talking Points:

      • Your PCP may manage your condition, or you may be referred to a GI specialist
      • Make sure to report any new, worsening, or persistent symptoms to your healthcare provider

      Sources: