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
03 Oct 2019
Early enteral nutrition (EEN) speeds up the recovery of gastrointestinal function after laparoscopic common bile duct exploration (LCBDE), according to a study. However, EEN also increases complications such as diarrhoea and abdominal distension.
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.