Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease is a topic covered in the 5-Minute Emergency Consult.

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Basics

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

  • 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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Basics

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

  • 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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