gastroesophageal%20reflux%20disease
GASTROESOPHAGEAL REFLUX DISEASE
Gastroesophageal reflux disease is a disorder in which gastric contents recurrently reflux into the esophagus, causing troublesome symptoms and/or complications.
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.
Regurgitation is the perception of flow of refluxed gastric contents into the mouth or hypopharynx.
Heartburn is defined as burning sensation in the retrosternal region.

Definition

  • Disorder in which gastric contents recurrently reflux into the esophagus, causing troublesome symptoms and/or complications, eg injury of the esophageal mucosa and adjacent structures
    • Symptoms become “troublesome” when they adversely affect a patient’s well-being - moderate to severe symptoms occurring on >1 days/week 

Etiology

  • Produced by various mechanisms such as frequent occurrence of transient relaxation of the lower esophageal sphincter (LES), pressure abnormalities in the lower esophageal sphincter (which can be caused by hormonal and neural mediators, food, drugs and patient lifestyle)
    • Other factors in the pathology of GERD include poor esophageal clearance, delayed gastric emptying time, hiatal hernia

Signs and Symptoms

  • Typical symptoms are acid regurgitation and heartburn
    • Regurgitation is the perception of flow of refluxed gastric contents into the mouth or hypopharynx
    • Heartburn is defined as a burning sensation in the retrosternal region
  • Other presenting symptoms include, nausea, chest pain, epigastric pain, belching, early satiety, bloating
    • Non-cardiac chest pain (NCCP) is common among Asian patients and may be a presenting feature of GERD

Risk Factors

Risk Factors Linked to GERD

  • Age and male sex - associated with a higher incidence of esophagitis
  • Obesity - 2.5x more likely to have GERD than those with normal body mass index (BMI); overweight and obesity contribute to the increasing prevalence of GERD in the Asia-Pacific region
  • Alcohol
  • Smoking
  • Hiatus hernia - presence and size of a hiatal hernia are associated with a more incompetent LES, defective peristalsis, increased acid exposure and more severe mucosal damage

Precipitating Factors Linked to GERD

  • Coffee, chocolate, fatty foods
  • Acidic foods (eg spicy foods, citrus, carbonated drinks)
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
18 Sep 2019
Mortality, length of stay (LOS) and hospital charges are significantly higher in chronic liver disease (CLD) patients with fractures, a recent study has shown. These findings are also associated with increased infection, bleeding and poorer wound healing.
01 Aug 2017
New drug applications approved by US FDA as of 16 - 30 June 2017 which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.
Roshini Claire Anthony, 04 Oct 2017

Using a reduced computed tomography (CT) dose to diagnose appendicitis in adolescents and young adults does not appear to affect clinical outcomes, and could potentially reduce the long-term risk of radiation-related cancers, according to results of the LOCAT* trial. 

22 Sep 2019
Oral supplementation with the gut commensal bacterium Akkermansia muciniphila safely improves several metabolic parameters in overweight or obese adults, as shown in a proof-of-concept study.