Gastroesophageal Reflux Disease

Basics

Spectrum of pathology in which gastric reflux causes symptoms and damage to esophageal mucosa
Reflux esophagitis vs. nonerosive reflux disease
Prevalence in North America is 18.1–27.8%

Incompetent reflux barrier allowing increase in frequency and duration of gastric contents into esophagus
Lower esophageal sphincter (LES):
- Main antireflux barrier
- Crural diaphragm attachment (diaphragmatic sphincter)
- Contributes to pressure barrier at gastroesophageal junction
- Esophageal acid clearance via peristalsis and esophageal mucosal resistance are additional barriers
- Most healthy individuals have brief episodes of reflux without symptoms
Transient lower esophageal sphincter relaxations (TLESRs):
- Occur with higher frequency in gastroesophageal reflux disease (GERD) patients
- Exposed esophageal mucosa becomes acidified and with time necroses
Decreased LES tone:
- Smoking
- Foods: Alcohol, chocolate, onion, coffee, tea
- Drugs: Calcium channel blockers, morphine, meperidine, barbiturates, theophylline, nitrates
Delayed gastric emptying, increased body mass, and gastric distention contribute to reflux
Hiatal hernias associated with GERD:
- Significance varies in any given individual
- Most persons with hiatal hernias do not have clinically evident reflux disease
Acid secretion is same in those with or without GERD
Associated medical conditions: Pregnancy, chronic hiccups, cerebral palsy, Down syndrome, autoimmune diseases, diabetes mellitus (DM), hypothyroidism

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