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===Laboratory Findings===
===Laboratory Findings===
Laboratory findings consistent with diagnosis of GERD is the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring.


===X ray ===
===X ray ===
X ray imaging suggestive for associated problems with GERD include free acid reflux, esophagitis with scarring, strictures, and barrett's esophagus.


=== CT scan ===
=== CT scan ===
Line 52: Line 54:
=== Echocardiography or ultrasound ===
=== Echocardiography or ultrasound ===
There are no ultrasound findings associated with GERD.
There are no ultrasound findings associated with GERD.
=== Other Imaging Studies ===
There are no other imaging findings associated with GERD. However, Endoscopy may be used in screening for the complications associated with chronic GERD like barrett's esophagus.


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with GERD.


==Treatment==
==Treatment==

Revision as of 16:21, 5 December 2017

Gastroesophageal reflux disease Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Gastroesophageal Reflux Disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Gastroesophageal reflux disease is defined as chronic symptoms due to damage to the esophageal mucosa as a result of abnormal reflux of acidic stomach contents into the esophagus[1]. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter (LES), transient LES relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. Chronic GERD is associated with an increased risk of Barrett's esophagus which is a premalignant condition of the esophageal mucosa which is in turn associated with an increased risk of adenocarcinoma of the esophagus.

Historical Perspective

GERD is believed to be first described and treated by the ancient Egyptians according to the papyrus which was discovered by Edwin Smith at Thebes. The esophagus itself was named by the ancient Greeks. Friedenwald and Feldman described the symptoms of GERD in 1925. Robbins and Jankelson used the radiological procedures to observe GERD in 1926.

Classification

GERD can be classified based on the endoscopic appearance of the esophageal mucosa and the clinical presentation of the disease.

Pathophysiology

Pathophysiology of GERD depends on several mechanisms that lead to the retrograde movement of the acidic content of the stomach to the esophagus. These mechanisms include transient lower esophageal sphincter relaxation, hypotensive lower esophageal sphincter, hiatal hernia, and prolonged esophageal acid clearance.

Causes

Common causes of GERD include obesity, autonomic neuropathy, systemic sclerosis, esophageal achalasia, and hiatus hernia. Other causes of GERD include hypochlorhydria, hypercalcemia, and Zollinger-Ellison syndrome.

Differentiating Gastroesophageal reflux disease overview from Other Diseases

GERD must be differentiated from other diseases like gastritis, peptic ulcer, crohn's disease, gastric adenocarinoma, and gastrinoma.

Epidemiology and Demographics

The prevalence of GERD in USA and Europe ranges from 10,000 to 20,000 per 100,000 people. The incidence of GERD increases with age especially above 40 years.

Risk Factors

Common risk factors of GERD include smoking, obesity, pregnancy, alcohol binge drinking, and medications like the anticholinergic drugs. Other risk factors include some kinds of food like spicy food and bad eating habits like eating large meals.

Screening

There is insufficient evidence to recommend routine screening for GERD.

Natural History, Complications, and Prognosis

If left untreated, 20% of patients with GERD may progress to develop esophageal stricture due to excessive acid in the lower esophagus. Complications of GERD include barrett's esophagus, erosive esophagitis, esophageal ulcer, and esophageal adenocarcinoma. Prognosis of GERD is good with the appropriate treatment.

Diagnosis

History and Symptoms

Common symptoms of GERD include heart burn, regurgitation, and dysphagia. A positive history of nausea, vomiting and regurgitation is suggestive of GERD. Other symptoms of GERD include chest pain, cough, and odynophagia.

Physical Examination

Patients with GERD usually appear ill due to the pain. Common physical examination include hoarseness of voice, laryngitis, otitis media, and lung wheezes.

Laboratory Findings

Laboratory findings consistent with diagnosis of GERD is the presence of acidic reflux in the esophagus through the ambulatory reflux monitoring.

X ray

X ray imaging suggestive for associated problems with GERD include free acid reflux, esophagitis with scarring, strictures, and barrett's esophagus.

CT scan

There are no CT findings associated with GERD.

MRI scan

There are no MRI findings associated with GERD.

Echocardiography or ultrasound

There are no ultrasound findings associated with GERD.

Other Imaging Studies

There are no other imaging findings associated with GERD. However, Endoscopy may be used in screening for the complications associated with chronic GERD like barrett's esophagus.

Other Diagnostic Studies

There are no other diagnostic studies associated with GERD.

Treatment

Medical Therapy

Surgery

Prevention

References

  1. DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1999;94:1434-42. PMID 10364004.

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