occurs when the amount gastric juice that refluxes into the esophagus exceeds the normal limit, causing symptoms with or without associated esophageal mucosal injury.
Prevalence:
- Affect all ages and both sexes.
- Very common, 10% of population have daily symptoms and 33% of population have intermittent symptoms
Pathophysiology:
The following factors protect against occurrence of GERD. impairment of one or more of these factors may lead to GERD:
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I. Competent gastroesophageal junction. e.g Impairment can occur in the form of decrease lower esophageal sphincter (LES) tone.
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II. Effective esophageal clearing through esophageal peristalsis.
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III. Neutralization of refluxed fluid by saliva.
Presentation of GERD:
I. Typical Symptoms: Heart burn and/or regurgitation and halitosis.
II. Extra- esophageal manifestations:
- -Non cardiac chest pain which may be typical to angina however never diagnosed except after exclusion of coronary heart disease.
- -Asthma.
- -Chronic cough
- -Pneumonia and pneumonitis
- -Laryngitis
- -Hoarseness of voice
Ill. Manifestations of complications:
- Erosive esophagitis causing hematemesis.
- Peptic stricture causing dysphagia.
- Barrett’s esophagitis (columnar metaplasia): a condition in which specialized intestinal type columnar mucosa replaces the normal squamous mucosa in response to chronic gastro esophageal reflux disease with increased risk of adenocarcinoma. Endoscopy with biopsy is recommended for Barrett’s esophagus but not chronic gastroesophageal reflux disease.
Diagnosis of GERD:
- Presence of typical symptoms.
- Endoscopy: showing inflammation and/or complications in lower esophagus.
- 24-hour Ambulatory pH monitoring: detecting abnormal acid reflux.
Treatment:
- Active Disease: by acid suppression:
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H-2 receptor blockcers for mild disease. Options include ranitidine, cimetidine, famotidine and nizatidine
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Proton pump inhibitors for moderate or severe disease e.g. omeprazole, lansoprazole and esmoprazole.
- Long term therapy: to avoid recurrence:
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Life style modification: reduce weight, stop smoking, small frequent diet, raise bed head and avoid late meals.
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Infrequent symptoms: intermittent acid suppression therapy.
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Frequent symptoms: long term therapy or surgery (fundoplication).