Gastroesophageal reflux disease is a condition which results from the recurrent backflow of gastric contents into the esophagus and adjacent structures causing troublesome symptoms and/or tissue injury.
It is produced by various mechanisms such as frequent occurrence of transient relaxation of the lower esophageal sphincter or pressure abnormalities in the lower esophageal sphincter (which can be caused by hormonal and neural mediators, food, drugs and patient lifestyle).
Typical symptoms are acid regurgitation and heartburn.
Acid regurgitation is the perception of flow of refluxed gastric contents into the mouth or hypopharynx.
Heartburn is the burning sensation in the retrosternal region.
Pregnant women who have GERD should also be offered lifestyle modification as 1st-line therapy
All patients should be educated regarding factors that may worsen their GERD symptoms but lifestyle modifications alone typically do not provide adequate relief for most GERD patients
Advice should be tailored to the circumstances of the individual patient:
Avoidance of foods/drinks that may precipitate heartburn (eg spicy foods, onion, tomato-based products, citrus, carbonated drinks) and/or reflux (eg alcohol, coffee, chocolate, peppermint, fatty foods)
Avoidance of medications that lower LES pressure [eg calcium channel blockers, beta-agonists, alpha-adrenergic agonists, Theophylline, nitrates, phosphodiesterase-5 (PDE-5) inhibitors] or irritate the esophagus (eg Ferrous sulfate, NSAIDs, bisphosphonates)
Adoption of behaviors that will help reduce esophageal acid exposure
Weight loss should be advised for obese or overweight patients
Smoking cessation
Elevation of the head of the bed for patients who are troubled with heartburn or regurgitation when recumbent
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