GERD, Gastroesophageal Reflux Disease

Clinic

• GERD or gastro-oesophageal reflux disease (GORD) is one of the upper GI chronic diseases where stomach content persistently and regularly flows up into the esophagus
• Risk factors include obesity, pregnancy, smoking, hiatal hernia, and taking certain medications.
• Acid reflux is due to poor closure of LES

2 Signs and symptoms

2.1 Adults

• The most common symptoms are an Acidic taste in the mouth, Regurgitation, and Heartburn.
• Less common symptoms include Odynophagia, Sore throat, Increased salivation (Water brash), nausea, chest pain, coughing, and globus sensation.
• Acid reflux can induce asthma attack symptoms like shortness of breath, cough, and wheezing in those with underlying asthma.

• Complication: Reflux esophagitis, Esophageal strictures, Barrett's esophagus, Esophageal adenocarcinoma, Laryngeal injury and Aspiration pneumonia.
• Note that these are dynamic post nodes

2.2 Children / Babies

• GERD may be difficult to detect in infants and children since they cannot describe it.
• It may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing.
• Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again,
• Failure to gain adequate weight, bad breath, and burping are also common.
• Children may have one symptom or many; no single symptom is universal in all children with GERD.

3 Entities

• Stomach, Eructation
• Gastric dilation

4 Miasms

• PLV

5 Related disease

• Achalasia: GERD is due to poor closure of LES but achalasia is characterized by incomplete LES relaxation/ Increased LES tone, and lack of esophageal peristalsis.
• Gastroparesis
• Ileus
• Sandifer syndrome

6 Causes

Factors that can contribute to GERD:

• Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors.
• Obesity: increasing body mass index is associated with more severe GERD. In a large series of 2,000 patients with symptomatic reflux disease, it has been shown that 13% of changes in esophageal acid exposure is attributable to changes in body mass index.

Factors that have been linked with GERD, but not conclusively:

• Obstructive sleep apnea
• Gallstones, which can impede the flow of bile into the duodenum, which can affect the ability to neutralize gastric acid

In 1999, a review of existing studies found that, on average, 40% of GERD patients also had H. pylori infection. The eradication of H. pylori can lead to an increase in acid secretion, leading to the question of whether H. pylori-infected GERD patients are any different than non-infected GERD patients. A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.