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GASTROESOPHAGEAL REFLUX DISEASE
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.

Definition

  • A condition which results from the recurrent backflow of gastric contents into the esophagus and adjacent structures causing troublesome symptoms and/or tissue injury
    • 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 heartburn and acid regurgitation
    • Heartburn is the burning sensation in the retrosternal region
    • Acid regurgitation is the perception of flow of refluxed gastric contents into the mouth or hypopharynx
  • 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
    • In an Asian study, a BMI of >25 was a significant risk factor for GERD
  • 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)
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