Gastroesophageal Reflux Disease (GERD) - Summary



GERD: Diagnosis

• Heartburn (substernal burning sensation) and acid regurgitation

• Chest pain

Extraesophageal manifestations

• Chest pain, cough, hoarseness, and wheezing

Laryngeal and pulmonary symptoms

• Hoarseness, throat clearing, chronic cough



GERD: Testing

EGD indications → PPI failure or alarm symptoms

• Dysphagia/odynophagia

• Unintentional weight loss

• Hematemesis/melena

• Vomiting

• Anemia



Therapeutic trial of PPI

• Once daily trial x 8 weeks

• Complete relief → discontinue PPI

• Incomplete/relief/treatment/failure/symptom recurrence → EGD off PPI 2-4 weeks



GERD - Testing

Ambulatory reflux monitoring (pH or impedance pH)

 • PPI failure + negative EGD

Impedance testing

Esophageal manometry

• Refractory GERD when EGD and pH monitoring are inconclusive

• Before antireflux surgery (exclude motility disorders)



Alarm features:

• Anemia

• Dysphagia

• Vomiting

• Weight loss



Screening - Symptoms for 5 or more years and three or more risk factors:

• Male sex

• Age >50 years

• White race

• Tobacco smoking

• Obesity

• Family history of Barrett esophagus or esophageal adenocarcinoma in a first-degree relative) to detect BE.



GERD - Complications:

• Erosive esophagitis

• Stricture

• Barrett esophagus

• Esophageal adenocarcinoma



Extraesophageal complications:

• Cough

• Laryngitis

• Asthma

• Dental erosion



GERD - Nonpharmacologic Treatment:

• Weight reduction

• Avoid “trigger” foods: caffeine, spicy foods, citrus

• Eat 2-3 hours before going to bed

• Smoking cessation

• Elevate head of bed



GERD Treatment - Antireflux surgery:

• Failure of optimal therapy

• Desire to stop medication

• Intolerable medication adverse effects



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