Definition of Gastroesophageal reflux disease:

Gastroesophageal reflux disease (GERD) is a condition in which food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, 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.

A number of studies suggest that obesity contributes to gastroesophageal reflux. For instance, the Nurses Health Study found that being overweight or obese significantly increased reflux symptoms in women. (Women who lost weight in the study, meanwhile, had fewer symptoms.)

Symptoms:

• Heartburn
  • Involves a burning pain in the chest (under the breastbone)
  • Increased by bending, stooping, lying down, or eating
  • Relieved by antacids
  • 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:

• A positive stool guaiac
• Continuous esophageal pH monitoring showing reflux
• Endoscopy showing ulceration or inflammation of the esophagus
• Esophageal manometry showing abnormal sphincter pressure
• A barium swallow showing reflux
• A positive Bernstein test for gastric acid reflux

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

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

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.