Gastroesophageal Reflux Disease (GERD) - Summary GERD: Diagnosis • Heartburn (substernal burning sensation) and acid regurgitation • Chest pain Extraesophageal manifestations • Chest pain, cough, hoarseness, and wheezing Laryngeal and pulmonary symptoms • Hoarseness, throat clearing, chronic cough GERD: Testing EGD indications → PPI failure or alarm symptoms • Dysphagia/odynophagia • Unintentional weight loss • Hematemesis/melena • Vomiting • Anemia Therapeutic trial of PPI • Once daily trial x 8 weeks • Complete relief → discontinue PPI • Incomplete/relief/treatment/failure/symptom recurrence → EGD off PPI 2-4 weeks GERD - Testing Ambulatory reflux monitoring (pH or impedance pH) • PPI failure + negative EGD Impedance testing Esophageal manometry • Refractory GERD when EGD and pH monitoring are inconclusive • Before antireflux surgery (exclude motility disorders) Alarm features: • Anemia • Dysphagia • Vomiting • Weight loss Screening - Symptoms for 5 or more years and three or more risk factors: • Male sex • Age >50 years • White race • Tobacco smoking • Obesity • Family history of Barrett esophagus or esophageal adenocarcinoma in a first-degree relative) to detect BE. GERD - Complications: • Erosive esophagitis • Stricture • Barrett esophagus • Esophageal adenocarcinoma Extraesophageal complications: • Cough • Laryngitis • Asthma • Dental erosion GERD - Nonpharmacologic Treatment: • Weight reduction • Avoid “trigger” foods: caffeine, spicy foods, citrus • Eat 2-3 hours before going to bed • Smoking cessation • Elevate head of bed GERD Treatment - Antireflux surgery: • Failure of optimal therapy • Desire to stop medication • Intolerable medication adverse effects #GERD #Gastroesophageal #Reflux #Disease #diagnosis #management #Gastroenterology
