Gastroesophageal reflux disease

Alternative names
Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic

Definition
Gastroesophageal Reflux Disease (GERD) is a condition in which food or liquid travels from the stomach back up into the esophagus (the tube from the mouth to the stomach). This partially digested material is usually acidic, and can irritate the esophagus, often causing Heartburn and other symptoms.

Causes, incidence, and risk factors

Gastroesophageal reflux is a common condition that often occurs without symptoms after meals. In some people, the reflux is related to a problem with the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach. If this sphincter doesn’t close properly, food and liquid can move backward into the esophagus and may cause the symptoms.

The risk factors for reflux include hiatal hernia, pregnancy, and scleroderma.

Symptoms

     
  • Heartburn       o Involves a burning pain in the chest (under the breastbone)       o Increased by bending, stooping, lying down, or eating       o Relieved by antacids       o More frequent or worse at night  
  • Belching  
  • Regurgitation of food  
  • nausea and vomiting  
  • Vomiting blood  
  • Hoarseness or change in voice  
  • Sore throat  
  • Difficulty swallowing  
  • Cough or Wheezing

Signs and tests

Treatment
General measures include:

     
  • Weight reduction  
  • Avoiding lying down after meals  
  • Sleeping with the head of the bed elevated  
  • Taking medication with plenty of water  
  • Avoiding dietary fat, chocolate, caffeine, peppermint (they may cause lower esophageal pressure)  
  • Avoiding alcohol and tobacco

Medications that alleviate symptoms include:

     
  • Antacids after meals and at bedtime  
  • Histamine H2 receptor blockers  
  • Promotility agents  
  • Proton pump inhibitors

Proton pump inhibitors
— A variety of proton pump inhibitors are available by prescription, including omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex).

Anti-reflux operations (Nissen fundoplication) may help a small number of patients who have persistent symptoms despite medical treatment. There are also new therapies that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach) for reflux.

Expectations (prognosis)
The majority of people respond to nonsurgical measures with behavioral modification and medications.

Complications

     
  • Inflammation of the esophagus  
  • Stricture  
  • Esophageal ulcer  
  • Hoarseness, bronchospasm  
  • Chronic pulmonary disease  
  • Barrett’s esophagus (a change in the lining of the esophagus that can increase the risk of cancer)

Calling your health care provider
Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.

Prevention
Avoid foods and activities that worsen symptoms. Maintain a healthy weight.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

Medical Encyclopedia

  A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 0-9

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.