Gastroesophageal reflux disease

Background

  • Abbreviation: GERD
  • Definition: a highly variable chronic condition that is characterized by periodic episodes of backward flow of the gastric contents into the esophagus due to improper functioning of a sphincter at the lower end of the esophagus
    • Usually accompanied by "heartburn" symptoms and histopathologic changes in the esophagus
  • Affects up to 20% of population
  • Assume chest pain is cardiac origin until proven otherwise

Causes

  • Decreased pressure of lower esophageal sphincter
    • High-fat food
    • Nicotine
    • Ethanol
    • Caffeine
    • Medications (mintrates, calcium-channel blockers, anticholinergics, progesterone/estrogen)
    • Pregnancy
  • Decreased esophageal motility
  • Prolonged gastric emptying
  • High-fat food

Clinical Features

Typical

  • Pain and discomfort with or right after meals
    • typically described as burning pain
    • often worse when lying flat
  • +/-Dysphagia

Atypical

  • Chest pain with features similar to ACS:
    • Exertional, associated with diaphoresis, nausea/vomiting, radiating to arm
  • Asthma
  • Pneumonia
  • Hoarseness
  • Aspiration

Pediatric

  • Reflux is physiologic in infants
  • Pathologic only if it causes complications, such as:

Differential Diagnosis

Epigastric Pain

Management

  • Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
  • Sleep with head of bed elevated
  • Avoid eating within 3hr of sleep
  • PPI or H2 blocker

Infants

  • Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds
    • medications only if significant complications

Disposition

  • Home (outpatient treatment)

See Also

  • Abdominal Pain

References

  1. Ranjitkar S, Kaidonis JA, Smales RJ (2012). "Gastroesophageal Reflux Disease and Tooth Erosion". International Journal of Dentistry. 2012: 479850. doi:10.1155/2012/479850. ISSN 1687-8728. PMC 3238367. PMID 22194748.
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