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Gastroesophageal Reflux Disease

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

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  • Spectrum of pathology in which gastric reflux causes symptoms and damage to esophageal mucosa
  • Reflux esophagitis vs. nonerosive reflux disease
  • 40% of general population experience symptoms monthly


  • 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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Rosen, Peter, et al., editors. "Gastroesophageal Reflux Disease." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/all/Gastroesophageal_Reflux_Disease.
Gastroesophageal Reflux Disease. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/all/Gastroesophageal_Reflux_Disease. Accessed April 23, 2019.
Gastroesophageal Reflux Disease. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/all/Gastroesophageal_Reflux_Disease
Gastroesophageal Reflux Disease [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/all/Gastroesophageal_Reflux_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gastroesophageal Reflux Disease ID - 307569 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307569/all/Gastroesophageal_Reflux_Disease PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -