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Gastroesophageal reflux disease

Last reviewed: 6 Apr 2025
Last updated: 28 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • heartburn
  • acid regurgitation
Full details

Other diagnostic factors

  • dysphagia
  • bloating/early satiety
  • laryngitis
  • globus
  • enamel erosion
  • halitosis
  • dyspepsia
Full details

Risk factors

  • family history of heartburn or GERD
  • older age
  • hiatal hernia
  • obesity
  • use of lower esophageal sphincter (LES) tone-reducing drugs
  • psychological stress
  • asthma
  • use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • smoking
  • alcohol consumption
  • peroral endoscopic myotomy (POEM)
  • dietary factors
  • pregnancy
Full details

Diagnostic tests

1st tests to order

  • proton-pump inhibitor (PPI) trial
Full details

Tests to consider

  • esophagogastroduodenoscopy (EGD)
  • ambulatory pH monitoring
  • esophageal manometry
  • combined impedance-pH testing
  • barium swallow
  • esophageal capsule endoscopy
Full details

Emerging tests

  • endolumenal functional lumen imaging probe

Treatment algorithm

ACUTE

initial presentation

ONGOING

nonpregnant: proton-pump inhibitor-responsive

nonpregnant: incomplete response to proton-pump inhibitor

pregnant: intractable symptoms or complicated reflux disease

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 is on the speakers bureau for Phathom Pharmaceuticals.

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: AstraZeneca (consultant, speakers bureau, grant support); Takeda (grant support); Pentax (speaker, travel); Wyeth (consultant); and C2 Therapeutics (consultant).

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text  Abstract

Muthusamy VR, Lightdale JR, Acosta RD, et al; ASGE Standards of Practice Committee. The role of endoscopy in the management of GERD. Gastrointest Endosc. 2015;81(6):1305-10.Full text  Abstract

Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017 Mar;152(4):706-15. Abstract

Ness-Jensen E, Hveem K, El-Serag H, et al. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2016 Feb;14(2):175-82.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Gastroesophageal reflux disease images
  • Differentials

    • Acute coronary syndrome
    • Stable angina
    • Functional esophageal disorder/functional heartburn
    More Differentials
  • Guidelines

    • ACR practice parameter for the performance of esophagrams and upper gastrointestinal examinations in adults
    • Clinical practice update on the diagnosis and management of extraesophageal gastroesophageal reflux disease
    More Guidelines
  • Patient information

    GERD: questions to ask your doctor

    Acid reflux, heartburn, and gastroesophageal reflux disease (GERD)

    More Patient information
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