Diseases, Disorders information

Gastroesophageal Reflux Disease
About 18% of the adult population in the United States have heartburn at least once a week. Gastroesophageal reflux describes the movement of gastric acid into the esophagus. The major antireflux barrier is the lower esophageal sphincter (LES), located at the esophagogastric junction. Patients with disordered esophageal motility from connective-tissue diseases or primary motility disorders and those with hyposalivation from chronic xerostomia, cigarette smoking, or anticholinergic medications are predisposed to increased severity of GERD.

Clinical evaluation

Heartburn, defined as a retrosternal burning sensation radiating to the pharynx, and acid regurgitation are classic symptoms of GERD. They usually occur postprandially, especially after large meals.

Symptoms may be exacerbated by recumbency, straining, and bending over and are usually improved by antacids. These symptoms are specific enough that their presence establishes the diagnosis of GERD without confirmatory tests.

Complications

Esophagitis with ulceration may result in gastrointestinal hemorrhage, which is reported in about 2% of patients with reflux esophagitis.

Esophageal strictures form in about 10% of patients with GERD. These patients are managed with periodic dilations and acid suppression with proton pump inhibitors.

Barrett’s esophagus. Metaplastic changes in the esophageal mucosa that result from GERD are referred to as Barrett’s esophagus. The presence of columnar-appearing epithelium more than 3 cm above the proximal gastric folds is a criterion for diagnosis. The reported incidence of adenocarcinoma in Barrett’s esophagus, which is considered a premalignant condition, is 1 in 52 patient-years.

Extraesophageal manifestations of GERD may include noncardiac chest pain, chronic hoarseness and cough, and asthma