Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- pirose
- regurgitação ácida
Other diagnostic factors
- disfagia
- distensão abdominal/saciedade precoce
- laringite
- globus
- erosão do esmalte
- halitose
- dispepsia
Risk factors
- história familiar de pirose ou DRGE
- idade avançada
- hérnia de hiato
- obesidade
- uso de medicamentos redutores do tônus do esfíncter esofágico inferior (EEI)
- estresse psicológico
- asma
- uso de anti-inflamatórios não esteroidais (AINEs)
- tabagismo
- consumo de bebidas alcoólicas
- miotomia endoscópica peroral (POEM)
- fatores alimentares
- gestação
Diagnostic investigations
1st investigations to order
- teste do inibidor da bomba de prótons (IBP)
Investigations to consider
- endoscopia digestiva alta (EDA)
- pH-metria (monitoramento do potencial hidrogeniônico [pH]) ambulatorial
- manometria esofágica
- teste combinado de pHmetria com impedância
- esofagografia baritada
- endoscopia por cápsula esofágica
Emerging tests
- sonda de imagem do lúmen funcional endoluminal
Treatment algorithm
apresentação inicial
não gestante: com resposta clínica a inibidor da bomba de prótons
não gestante: resposta incompleta a inibidor da bomba de prótons
gestante: sintomas não tratáveis ou doença do refluxo complicada
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).
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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.
Differentials
- Síndrome coronariana aguda
- Angina estável
- Distúrbio esofágico funcional/pirose funcional
More DifferentialsGuidelines
- 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 GuidelinesPatient information
Refluxo gastroesofágico, pirose e doença do refluxo gastroesofágico (DRGE)
Doença do refluxo gastroesofágico (DRGE): perguntas para fazer ao seu médico
More Patient information
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