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Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD): Symptoms, Diagnosis, and Management

Gastroesophageal reflux disease (GERD) is a chronic condition where stomach acid flows back into the esophagus, causing symptoms like heartburn and tissue damage. Below is a synthesis of its key aspects, supported by clinical guidelines and research.

Symptoms

GERD symptoms vary in severity and may include:

Common Symptoms	Atypical/Complications
Heartburn: Burning chest pain radiating to the throat.	Chronic cough, hoarseness, or sore throat.
Regurgitation: Sour/bitter stomach contents in the mouth.	Dysphagia (difficulty swallowing).
Bloating, nausea, or early satiety.	Chest pain (may mimic heart attack).
Burping or acid taste in the mouth.	Signs of bleeding: Black stools or vomiting blood.
Weight loss or unexplained fatigue.	Barrett’s esophagus (pre-cancerous changes).

Asymptomatic cases: ~20% of patients lack classic symptoms but may develop complications like strictures14.

Causes and Risk Factors

1. Lower Esophageal Sphincter (LES) Dysfunction:
   • Weakness or inappropriate relaxation: Allows acid reflux.
   • Hiatal hernia: Stomach protrudes into the chest, impairing LES function14.
2. Lifestyle Factors:
   • Obesity: Increases intra-abdominal pressure.
   • Diet: Citrus, chocolate, mint, or carbonated drinks relax the LES57.
   • Smoking/alcohol: Reduce LES tone and worsen symptoms57.
3. Medications:
   • NSAIDs, calcium channel blockers, or antidepressants exacerbate reflux14.
4. Congenital Defects:
   • Esophageal atresia or diaphragmatic hernias in infants4.

Diagnosis

1. Clinical Evaluation:
   • Symptom history: Heartburn/regurgitation frequency and triggers.
   • Physical exam: Assess for complications (e.g., weight loss).
2. Diagnostic Tests:
   • Upper endoscopy: Visualizes esophageal inflammation, strictures, or Barrett’s esophagus26.
   • pH monitoring: Measures acid exposure in the esophagus36.
   • Esophageal manometry: Evaluates LES function and motility36.

When to test: If symptoms persist despite initial treatment or to rule out complications26.

Treatment

Lifestyle Modifications

• Diet: Avoid triggers (e.g., citrus, alcohol, late-night meals).
• Weight loss: Reduces intra-abdominal pressure.
• Elevate the head: Sleep on a wedge pillow to prevent nighttime reflux17.

Medications

Class	Examples	Mechanism
Antacids	Tums, Rolaids	Neutralize stomach acid.
H2 blockers	Ranitidine	Reduce acid production.
Proton pump inhibitors (PPIs)	Omeprazole, lansoprazole	Block acid secretion (most effective).

Advanced Therapies

• Surgery: Fundoplication (wraps stomach around the esophagus) for refractory cases6.
• Endoscopic interventions: Radiofrequency ablation or transoral incisionless fundoplication (TIF)6.

Complications

1. Esophageal Stricture: Narrowing from chronic inflammation.
2. Barrett’s Esophagus: Pre-cancerous changes linked to esophageal adenocarcinoma.
3. Respiratory Issues: Aspiration pneumonia or chronic cough17.

Prognosis

• With treatment: Symptoms improve in 70–90% of patients.
• Untreated: Risk of strictures, Barrett’s esophagus, or esophageal cancer17.

Conclusion
GERD is a manageable condition requiring lifestyle adjustments and targeted therapies. Early diagnosis and adherence to treatment prevent complications like Barrett’s esophagus.

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References

1. NIDDK: GERD Symptoms & Causes
2. Johns Hopkins: GERD
3. Aurora Health Care: GERD
4. Cleveland Clinic: GERD
5. Samitivej Hospital: GERD
6. Mayo Clinic: GERD
7. MedicalNewsToday: GERD
8. StatPearls: GERD