| Pathophysiology | • Decreased tone or excessive transient relaxations of LES • Anatomic disruption to gastroesophageal junction (eg, hiatal hernia) • ↑ Risk with obesity, pregnancy, smoking, alcohol intake | | --- | --- | | Manifestations | • Regurgitation of acidic material in mouth resulting in sour taste • Heartburn • Odynophagia (often indicates reflux esophagitis) • Extraesophageal manifestations: Acidic gastric contents can irritate the larynx, leading to hoarseness, or it may be aspirated, leading to airway constriction (wheezing) and cough | | Complications | • Esophageal: erosive esophagitis, Barrett esophagus, strictures • Extraesophageal: asthma exacerbation, laryngitis | | Initial treatment | • Lifestyle (eg, weight loss) & dietary changes • H2R blocker or PPI |
Symptoms can be made worse or elicited by recumbency (eg, when sleeping at night), which facilitates retrograde gastric content flow.
often in association with consumption of a large meal or trigger food such as an acidic beverage, fatty foods, coffee, chocolate, or tomatoes.
Esophageal chest pain Vs Angina
GERD is diagnosed clinically. Further evaluation is warranted in patients who do not respond to PPIs. 24-hour esophageal pH monitoring is the gold-standard for the diagnosis of GERD and may detect increased concentrations of acid in the distal esophagus in patients who have not yet manifested esophagitis that may be identified endoscopically.