Gastroesophageal Reflux Disease

5-Minute Clinical Consult

Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease was found in 5-Minute Clinical Consult which helps you diagnose, treat, and follow up on over 900 medical conditions seen in everyday practice.

To view this entire topic, please or purchase a subscription.

Explore 5-Minute Clinical Consult - view these FREE monographs:

5-Minute Clinical Consult

-- The first section of this topic is shown below --

Basics

Description

Reflux of gastroduodenal contents into the esophagus, larynx, or lungs, with or without resultant esophageal inflammation

Pediatric Considerations
Symptoms (vomiting, weight loss, failure to thrive) usually resolve by 18 months.

Epidemiology

Incidence
Children affected: 1/300–1,000

Prevalence
  • Prevalence of gastroesophageal reflux disease (GERD): 10–20% in the US
  • Prevalence of Barrett esophagus: 1.5%
  • 65% adults have had heartburn; 15% have weekly symptoms
  • In a European population-based study, reflux symptoms were found only in 40% of subjects with Barrett esophagus, and in 1/3 of patients with documented esophagitis.

Risk Factors

  • Obesity
  • Alcohol use
  • Smoking
  • Caffeine use
  • Position of the acid pocket above the diaphragm in patients with hiatal hernia (see below) (1,2)

Genetics
Gene polymorphism identified

General Prevention

Positional treatment: Use infant seat for 2–3 hours after meals; thickened feedings:

  • Avoid alcohol, nicotine, and caffeine.
  • Avoid lying down immediately after a meal.
  • Elevate head of bed.

Etiology

  • Occurs with loss of the normal pressure gradient between the lower esophageal sphincter (LES) and the stomach
  • Most commonly due to inappropriate relaxation of LES:
    • Foods (high fat, spicy, citrus, chocolate, peppermint, onions)
    • Medications (anticholinergic, smooth muscle relaxants, i.e., calcium channel blockers, nitrates)
  • Other contributing factors include:
    • Pregnancy (progestational hormones decrease LES pressure)
    • Ineffective peristalsis
    • Scleroderma
    • Delayed gastric emptying
    • Positional: Recumbency, bending
  • Obesity

Commonly Associated Conditions

  • Reflux esophagitis: Due to exposure to acid, pepsin; classified as erosive (mucosal damage apparent, ulcers, friability) or nonerosive
  • Extraesophageal reflux:
    • Aspiration
    • Chronic cough
    • Laryngitis, vocal cord granuloma
    • Sinusitis
    • Otitis media
  • Halitosis
  • Hiatal hernia: The position of the acid pocket (the zone of high acidity detected in the proximal stomach after a meal) above the diaphragm in patients with hiatal hernia is a major risk factor (1,2).
  • Peptic stricture: In 10% with GERD
  • Barrett esophagus
  • Esophageal adenocarcinoma

-- To view the remaining sections of this topic, please or purchase a subscription --