Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a clinical diagnosis. The classic symptoms are heartburn and regurgitation. A therapeutic trial of a proton-pump inhibitor (PPI) can serve for both diagnosis and initial treatment.

Upper endoscopy is indicated to evaluate for complications; for atypical, persistent, or relapsing symptoms; or for alarm features (e.g., weight loss, anemia).

High rate of relapse upon stopping treatment.

Serious complications of GERD include stricture, Barrett esophagus, or esophageal carcinoma.

Gastroesophageal reflux disease (GERD) is defined as "the condition in which the reflux of gastric contents into the esophagus results in symptoms and/or complications''.[1]Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx http://www.ncbi.nlm.nih.gov/pubmed/34807007?tool=bestpractice.com [2]Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006 Aug;101(8):1900-20. http://www.ncbi.nlm.nih.gov/pubmed/16928254?tool=bestpractice.com [3]Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008 Oct;135(4):1383-91 http://www.gastrojournal.org/article/S0016-5085%2808%2901606-5/fulltext http://www.ncbi.nlm.nih.gov/pubmed/18789939?tool=bestpractice.com

Typical symptoms are heartburn and acid regurgitation. Extraesophageal symptoms include cough, laryngitis, asthma, or dental erosion.[1]Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx http://www.ncbi.nlm.nih.gov/pubmed/34807007?tool=bestpractice.com ​​[4]Sidhwa F, Moore A, Alligood E, et al. Diagnosis and treatment of the extraesophageal manifestations of gastroesophageal reflux disease. Ann Surg. 2017 Jan;265(1):63-7. http://www.ncbi.nlm.nih.gov/pubmed/27455157?tool=bestpractice.com [5]Fass R. Gastroesophageal Reflux Disease. N Engl J Med. 2022 Sep 29;387(13):1207-16. http://www.ncbi.nlm.nih.gov/pubmed/36170502?tool=bestpractice.com [6]Chen JW, Vela MF, Peterson KA, et al. AGA clinical practice update on the diagnosis and management of extraesophageal gastroesophageal reflux disease: expert review. Clin Gastroenterol Hepatol. 2023 Jun;21(6):1414-21.e3. https://www.cghjournal.org/article/S1542-3565(23)00143-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/37061897?tool=bestpractice.com ​​​ Atypical symptoms include dyspepsia, epigastric pain, nausea, bloating, and belching.[7]Gerson LB, Kahrilas PJ, Fass R. Insights into gastroesophageal reflux disease-associated dyspeptic symptoms. Clin Gastroenterol Hepatol. 2011 Oct;9(10):824-33. https://www.doi.org/10.1016/j.cgh.2011.05.015 http://www.ncbi.nlm.nih.gov/pubmed/21699806?tool=bestpractice.com

GERD may occur with or without esophageal inflammation (esophagitis). If erosions are present on endoscopic examination, the condition is called erosive reflux disease (ERD); if there are no erosions, it is called nonerosive reflux disease (NERD).[1]Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx http://www.ncbi.nlm.nih.gov/pubmed/34807007?tool=bestpractice.com