Gastroesophageal reflux disease (aka GERD) is a chronic disease where stomach acid comes up from the stomach into the esophagus, causing mucosal damage. Reflux is where this occurs in babies and young children, and is physiological.

• Caused by failure of the lower esophageal sphincter (i.e. barrier between the stomach and esophagus), whether permanent or temporary. It is caused by:
  • Abnormal relaxation in the lower esophageal sphincter (which normally holds the top of the stomach closed)
  • Impaired expulsion of gastric reflux from the esophagus
  • Hiatal hernia
  • Obesity
  • Zollinger-Ellison syndrome
  • High blood calcium, which can increase gastrin production, causing increased acidity
  • Scleroderm and esystemic sclerosis, which can cause esophageal dysmotility
  • Drugs, e.g. prednisolone
  • Visceroptosis or Glenard syndrome, where the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach
• Normally, the Angle of His (i.e. angle at which the esophagus enters the stomach) creates a valve that prevents duodenal bile, enzymes and stomacha cid from travelling back into the esophagus, where it can cause burning/inflammation of sensitive esophageal tissue

• Most commonly:
  • Regurgitation
  • Heartburn
• Painful swallowing
• Increased salivation
• Nausea
• Chest pain
• Coughing

In kids:

• Repeated vomiting
• Effortless spitting up
• Coughing, or other respiratory problems (e.g wheezing)
• Inconsolable crying
• Refusing food
• Crying for feed, and then pulling off the bottle or breast only to cry for it again
• Failure to gain adequate weight
• Bad breath
• Belching or burping

• Sx
• Short term Tx w/ PPI's, showing improvement in Sx, suggesting positive Dx
• EGD (esophagogastroduodenoscopy)
• Esophageal pH monitoring, the gold standard, allows monitoring GERD in pt's in their response to medical or surgical Tx
• Barium swallow x-rays, should NOT be used for Dx
• Esophageal manometry is NOT recommended for use in Dx being recommended only prior to surgery
• Ix for H pylori is usually NOT needed

• Lifestyle changes, including:
  • Weight loss
  • Elevating the head
  • Moderate exercise, improves Sx, although vigorous exercise may worsen Sx
  • Avoiding certain foods, especially before lying down, that promote GERD, although there is little evidence. Foods implicated include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods
  • Stopping smoking, and not drinking alcohol, do NOT appear to result in significant improvement in Sx
• Medications, including:
  • Antacids (see page)
  • PPI's (proton pump inhibitors)
  • H2 blockers
• Surgery, in those who don't improve, including:
  • Nissen fundoplication, where the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter, and prevent acid reflux, and to repair a hiatal hernia
  • LINX, involving a series of metal beeds w/ magnetic cores placed surgically around the lower esophageal sphincter

• Affects 10-20% of the population in the Western world