Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a condition in which retrograde flow of stomach contents into the esophagus or beyond into other regions, eg, oral cavity, larynx, or the lungs, occurs, primarily resulting in inflammation of the esophageal mucosa. This condition is considered one of the most common diseases encountered by gastroenterologists and primary care clinicians. The American College of Gastroenterology (ACG) defines GERD as chronic symptoms or mucosal damage incurred by the abnormal reflux of gastric contents into the esophagus and beyond. Reflux esophagitis secondary to GERD is typically classified as nonerosive reflux disease (NERD) with symptoms or symptomatic disease with esophageal erosions, termed erosive reflux disease. Although reflux esophagitis is generally more common in men, NERD is more prevalent in women. In Western countries, the prevalence of GERD is approximately 10% to 20%, and severe disease is observed in 6% of the population; in Asian countries, the prevalence is approximately 5%.  Esophageal reflux may result in complications, including esophagitis, upper gastrointestinal bleeding, anemia, esophageal stricturing, dysphagia, and Barrett esophagus. While GERD alone has been associated with an increased incidence of laryngeal and esophageal squamous cell carcinoma without a definite causal link , Barrett's esophagus is well-known to increase the risk of distal esophageal adenocarcinoma. GERD may also result in extra-gastrointestinal complications, including dental erosions, laryngitis, cough, asthma, sinusitis, and idiopathic pulmonary fibrosis. The most common symptoms of GERD are heartburn, regurgitation, and noncardiac chest pain. The diagnosis of GERD is primarily based on clinical features and patient response to proton pump inhibitors (PPIs). GERD can be presumptively diagnosed in most patients presenting with typical symptoms of heartburn and regurgitation. Additionally, several risk factors contribute to the development of GERD; recognition of these high-risk patients is critical to the timely initiation of preventative and mitigation strategies. Unless alarm symptoms, eg, dysphagia, odynophagia, anemia, weight loss, and hematemesis or melena are concurrent, most patients can be initiated on empiric therapy with PPIs without diagnostic evaluation. However, long-term pharmacologic treatment is indicated if atypical or alarm symptoms are present. The international Lyon Consensus recommends performing diagnostic confirmation of GERD in symptomatic patients before initiating long-term treatment for GERD. In patients who do not improve after taking PPIs, further diagnostic studies, eg, upper endoscopy and ambulatory wireless distal esophageal pH testing, should be performed to confirm GERD and exclude differential diagnoses.