Gastro-oesophageal reflux disease

Last reviewed: 2 Nov 2022
Last updated: 26 Jul 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • heartburn
  • acid regurgitation
More key diagnostic factors

Other diagnostic factors

  • dysphagia
  • bloating/early satiety
  • laryngitis
  • globus
  • enamel erosion
  • halitosis
  • dyspepsia
Other diagnostic factors

Risk factors

  • family history of heartburn or GORD
  • older age
  • hiatus hernia
  • obesity
  • lower oesophageal sphincter (LOS) tone-reducing drugs
  • psychological stress
  • asthma
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • smoking
  • alcohol consumption
  • per-oral endoscopic myotomy (POEM)
  • dietary factors
More risk factors

Diagnostic investigations

1st investigations to order

  • proton-pump inhibitor (PPI) trial
More 1st investigations to order

Investigations to consider

  • oesophagogastroduodenoscopy (OGD)
  • ambulatory pH monitoring
  • oesophageal manometry
  • combined impedance-pH testing
  • barium swallow
  • oesophageal capsule endoscopy
More investigations to consider

Emerging tests

  • endoluminal functional lumen imaging probe

Treatment algorithm

ACUTE

initial presentation

ONGOING

proton-pump inhibitor-responsive

incomplete response to proton-pump inhibitor

Contributors

Authors

Marc J. Zuckerman, MD

Professor of Medicine

Chief of Division of Gastroenterology

Texas Tech University Health Sciences Center

El Paso

TX

Disclosures

MJZ has been a speaker for Salix Pharmaceuticals, Allergan Pharmaceuticals, Takeda Pharmaceuticals, and has done contract research with Phathom Pharmaceuticals. He is an author of a reference cited in this topic.

Andres F. Carrion, MD

Associate Professor of Clinical Medicine

Division of Gastroenterology and Hepatology

University of Miami

Miami

FL

Disclosures

AFC declares that he has no competing interests.

Acknowledgements

Dr Marc J. Zuckerman and Dr Andres F. Carrion would like to gratefully acknowledge Dr. Sheila Feit and Dr. Mohamed Othman, previous contributors to this topic.

Disclosures

SF declares that she has no competing interests. MO has acted as a consultant for Olympus.

Peer reviewers

Lars Aabakken, MD

Professor of Medicine

Chief of GI Endoscopy

Rikshospitalet University Hospital

Oslo

Norway

Disclosures

LA declares that he has no competing interests.

Lise Lotte Gluud, MD, DMSc

Consultant

Department of Internal Medicine

Copenhagen University Hospital

Hellerup

Denmark

Disclosures

LLG declares that she has no competing interests.

Gary W. Falk, MD, MS

Professor of Medicine

Department of Gastroenterology & Hepatology

Center for Swallowing & Esophageal Disorders

Cleveland Clinic

Cleveland

OH

Disclosures

GWF has received fees from: Astra Zeneca (consultant, speakers bureau, grant support); Takeda (grant support); Pentax (speaker, travel); Wyeth (consultant); and C2 Therapeutics (consultant).

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  • Guidelines

    • American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
    • AGA clinical practice update on de-prescribing of proton pump inhibitors: expert review
    More Guidelines
  • Patient leaflets

    Heartburn

    GORD: questions to ask your doctor

    More Patient leaflets
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