Gastroesophageal Reflux Disease
Basics
Description
Description
- 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%
Etiology
Etiology
- 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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Citation
Schaider, Jeffrey J., et al., editors. "Gastroesophageal Reflux Disease." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/0.1/Gastroesophageal_Reflux_Disease.
Gastroesophageal Reflux Disease. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/0.1/Gastroesophageal_Reflux_Disease. Accessed December 3, 2024.
Gastroesophageal Reflux Disease. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/0.1/Gastroesophageal_Reflux_Disease
Gastroesophageal Reflux Disease [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/0.1/Gastroesophageal_Reflux_Disease.
* Article titles in AMA citation format should be in sentence-case
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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