GERD is the reflux of gastroduodenal contents into the esophagus with or without esophageal inflammation. Recent Gallup surveys reveal 65% of adults have suffered heartburn and 24% have had symptoms for more than 10 years.
Reflux disease is a risk factor for adenocarcinoma of the esophagus and gastric cardia.
GERD can be caused by: Inappropriate relaxation of lower esophageal sphincter (LES) (idiopathic, food- or drug-related); Pregnancy (progestational hormones cause decreased LES pressure); Scleroderma (reduced esophageal motility and incompetent LES); Chalasia of infancy; Delayed gastric emptying (impaired acid clearance); Acid hypersecretion (e.g., Zollinger-Ellison syndrome); and Heller's myotomy for achalasia (30% develop reflux)
Risk factors for GERD include: Foods that lower LES pressure (high-fat content, yellow onions, chocolate, peppermint); Foods that irritate esophageal mucosa (citrus fruits, spicy tomato drinks); Hiatal hernia - acid trapping; Cigarette smoking; Excessive alcohol; Coffee; Medications that lower LES pressure (e.g., theophylline, anticholinergics, progesterone, calcium channel blockers (nifedipine, verapamil), alpha adrenergic agents, diazepam, meperidine; Indwelling nasogastric tube; Chest trauma; and in children: Down syndrome, mental retardation, cerebral palsy, repaired tracheoesophageal fistula.
A significant proportion of patients with gastro-oesophageal reflux disease (GERD) have Helicobacter pylori infection.
Special tests for GERD include: esophageal pH monitoring, esophageal manometry, the acid perfusion (Bernstein) test, and gastric analysis. A barium swallow and Radionuclide scintigraphy may also be ordered.
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