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Gastroesophageal reflux disease
Classification and external resources
ICD-10 K21.
ICD-9 530.81
OMIM 109350
DiseasesDB 23596
eMedicine med/857  ped/1177 radio/300
MeSH D005764

Gastroesophageal reflux disease (American English and Canadian English) or Gastro-oesophageal reflux disease (British English, Hiberno-English, Australian English, New Zealand English, South African English) and abbreviated to either GERD or GORD is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Phonology North American English regional phonology In many ways compared to English English, North American English is conservative in its Phonology. Canadian English ( CanE, en-CA) is the variety of English used in Canada. British English or UK English ( BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the Hiberno-English also known as Anglo-Irish and Irish English is English as spoken in Ireland, partly the result of the interaction of the English Australian English ( AuE, AusE, en-AU) is the form of the English language used in Australia. New Zealand English ( NZE, en-NZ) is the form of the English language used in New Zealand. South African English ( SAE, en-ZA) is a Dialect of English spoken in South Africa and in neighbouring countries with a large number The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in [1]

This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following This can be due to incompetence of the cardia, transient cardia relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatus hernia. The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of A hiatus hernia or hiatal hernia is the protrusion (or Herniation) of the upper part of the Stomach into the Thorax through a tear or weakness

If the reflux reaches the throat, it is called laryngopharyngeal reflux disease. Laryngopharyngeal reflux (LPR refers to the backflow of stomach contents into the throat

Contents

Symptoms

Adults

Heartburn is the major symptom of acid in the esophagus, characterized by burning discomfort behind the breastbone (sternum). Heartburn or pyrosis is a painful or burning sensation in the Esophagus, just below the breastbone usually associated with regurgitation of gastric acid The sternum (from Greek στέρνον sternon, "chest" or breastbone) is a long flat Bone located in the center of the thorax (chest Findings in GERD include esophagitis (reflux esophagitis) — inflammatory changes in the esophageal lining (mucosa) —, strictures, difficulty swallowing (dysphagia), and chronic chest pain. Esophagitis (or Oesophagitis) is Inflammation of the Esophagus. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens A stenosis ( Plural: stenoses; from Ancient Greek στένωσις "narrowing" is an abnormal narrowing in a Blood vessel Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder In Medicine, chest pain is a Symptom of a number of serious conditions and is generally considered a Medical emergency. Patients may have only one of those symptoms. Typical GERD symptoms include cough, hoarseness, voice changes, chronic ear ache, burning chest pains, nausea or sinusitis. Sinusitis is an Inflammation of the Paranasal sinuses which may or may not be as a result of infection from Bacterial fungal, viral GERD complications include stricture formation, Barrett's esophagus, esophageal spasms, esophageal ulcers, and possibly even lead to esophageal cancer, especially in adults over 60 years old. Barrett's esophagus (UK Oesophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus or colloquially as Barrett's Esophageal cancer is malignancy of the Esophagus. There are various subtypes

Occasional heartburn is common but does not necessarily mean one has GERD. Patients with heartburn symptoms more than once a week are at risk of developing GERD. A hiatal hernia is usually asymptomatic, but the presence of a hiatal hernia is a risk factor for developing GERD. A hiatus hernia or hiatal hernia is the protrusion (or Herniation) of the upper part of the Stomach into the Thorax through a tear or weakness

Children

GERD may be difficult to detect in infants and children. CHILD syndrome (or congenital hemidysplasia with ichthyosiform erythroderma and limb defects) is a genetic disorder Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems. Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the In Medicine, a cough ( Latin: tussis) is a sudden and often repetitively occurring defence Reflex which helps to clear the large breathing passages Inconsolable crying, failure to gain adequate weight, refusing food, bad breath, and belching or burping are also common. Children may have one symptom or many — no single symptom is universal in all children with GERD.

It is estimated that of the approximately 4 million babies born in the U. S. each year, up to 35% of them may have difficulties with reflux in the first few months of their life. Most of those children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition.

Babies' immature digestive systems are usually the cause, and most infants stop having acid reflux by the time they reach their first birthday. Some children do not outgrow acid reflux, however, and continue to have it into their teen years. Children who have had heartburn that does not seem to go away, or any other GERD symptoms for a while, should talk to their parents and visit their doctor.

Diagnosis

Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach. This is a complication of chronic gastroesophageal reflux disease, and can be a cause of dysphagia or difficulty swallowing
Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach. The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following This is a complication of chronic gastroesophageal reflux disease, and can be a cause of dysphagia or difficulty swallowing

A detailed history taking is vital to the diagnosis. Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder Useful investigations may include barium swallow X-rays, esophageal manometry, 24-hour esophageal pH monitoring and Esophagogastroduodenoscopy (EGD). Barium (ˈbɛəriəm is a Chemical element. It has the symbol Ba, and Atomic number 56 X-radiation (composed of X-rays) is a form of Electromagnetic radiation. pH is the measure of the acidity or alkalinity of a Solution. In general, an EGD is done when the patient does not respond well to treatment, or has alarm symptoms including: dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes. Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Some physicians advocate once-in-a-lifetime endoscopy for patients with longstanding GERD, to evaluate the possible presence of Barrett's esophagus, a precursor lesion for esophageal adenocarcinoma. Barrett's esophagus (UK Oesophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus or colloquially as Barrett's Esophageal cancer is malignancy of the Esophagus. There are various subtypes

Esophagogastroduodenoscopy (EGD) (a form of endoscopy) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surfaces of the esophagus, stomach, and duodenum. Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum

Biopsies can be performed during gastroscopy and these may show:

Reflux changes may be non-erosive in nature, leading to the entity non-erosive reflux disease.

Pathophysiology

GERD is caused by a failure of the cardia. The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of In healthy patients the "Angle of His," the angle at which the esophagus enters the stomach, is in fact creating a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue.

Another paradoxical cause of GERD-like symptoms is not enough stomach acid (hypochlorhydria). Achlorhydria and hypochlorhydria refer to states where the production of Gastric acid in the Stomach is absent or low respectively The valve that empties the stomach into the intestines is triggered by acidity. If there is not enough acid this valve does not open, and the stomach contents are churned up into the esophagus. However, there is still enough acidity to irritate the esophagus.

Factors that can contribute to GERD:

GERD has been linked to laryngitis, chronic cough, pulmonary fibrosis, earache, and asthma, even when not clinically apparent, as well as to laryngopharyngeal reflux and ulcers of the vocal cords. A hiatus hernia or hiatal hernia is the protrusion (or Herniation) of the upper part of the Stomach into the Thorax through a tear or weakness Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected The body mass index ( BMI) or Quetelet index, is a statistical measurement which compares a person's weight and height Zollinger-Ellison syndrome is a disorder where increased levels of the hormone Gastrin are produced causing the Stomach to produce excess Hydrochloric acid In humans gastrin is a Hormone that stimulates secretion of Gastric acid (HCl by the Parietal cells of the Stomach, as well as aiding in Hypercalcaemia (in American English '''Hypercalcemia''' is an elevated calcium level in the Blood. In humans gastrin is a Hormone that stimulates secretion of Gastric acid (HCl by the Parietal cells of the Stomach, as well as aiding in Scleroderma is a chronic Autoimmune disease characterized by a hardening or Sclerosis in the Skin or other organs Scleroderma is a chronic Autoimmune disease characterized by a hardening or Sclerosis in the Skin or other organs Laryngitis is an Inflammation of the Larynx. It causes hoarse voice or the complete loss of the voice because of irritation to the Vocal folds In Medicine, a cough ( Latin: tussis) is a sudden and often repetitively occurring defence Reflex which helps to clear the large breathing passages Idiopathic pulmonary fibrosis (IPF, also known as cryptogenic fibrosing alveolitis, is a Chronic, progressive interstitial lung disease with an unknown Otalgia is ear pain or an earache. Primary otalgia is from Pain that originates inside the Ear. Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are The vocal folds, also known commonly as vocal cords, are composed of twin infoldings of Mucous membrane stretched horizontally across the Larynx.

Factors that have been linked with GERD but not conclusively:

Treatment

Physicians recommend lifestyle modifications when not recommending drugs to treat GERD. Sleep apnea is a sleep disorder characterized by pauses in Breathing during Sleep. In Medicine, gallstones (choleliths are Crystalline bodies formed within the body by accretion or concretion of normal or abnormal Bile component Bile or gall is a bitter yellow or green Alkaline fluid secreted by Hepatocytes from the Liver of most Vertebrates In many species In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. A 2006 review suggested that evidence for most dietary interventions is anecdotal; only weight loss and elevating the head of the bed were supported by evidence[6]. Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid A subsequent randomized crossover study showed benefit by avoiding eating two hours before bed. A crossover trial also referred to as a crossover study is a Clinical trial in which patients are given all of the medications to be studied or one medication and [2]

Foods

Certain foods and lifestyle are considered to promote gastroesophageal reflux:

Positional therapy

Sleeping on the left side has been shown to drastically reduce nighttime reflux episodes in patients. [8].

Elevating the head of the bed is also effective. Additional conservative measures may be considered if there is incomplete relief. Another approach is to apply all conservative measures for maximum response. A meta-analysis suggested that elevating the head of bed is an effective therapy, although this conclusion was only supported by nonrandomized studies [6]. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses

The head of the bed can be elevated by plastic or wooden bed risers that support bed posts or legs, a bed wedge pillow, or a wedge or an inflatable mattress lifter that fits in between mattress and box spring. The height of the elevation is critical and must be at least 6 to 8 inches (15 to 20 cm) to be at least minimally effective to prevent the backflow of gastric fluids. It should be noted that some innerspring mattresses do not work well when inclined and tend to cause back pain, thus foam mattresses are to be preferred. Some practitioners use higher degrees of incline than provided by the commonly suggested 6 to 8 inches (15 to 20 cm) and claim greater success.

Drug treatment

A number of drugs are registered for GERD treatment, and they are among the most-often-prescribed forms of medication in most Western countries. Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease They can be used in combination with other drugs, although some antacids can interfere with the function of other drugs:

Posture and GERD

In adults, a slouched posture is an important factor contributing to GERD. With a slouched posture there is no straight path between the stomach and esophagus; muscles around the esophagus go into a spasm. Gas and acidity get blocked in the spasm, causing coughing and other asthma-like symptoms. A meta-analysis suggested that elevating the head of the bed is an effective therapy, although this conclusion was only supported by nonrandomized studies. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses [6]

Surgical treatment

The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication. Nissen fundoplication is a Surgical procedure to treat Gastroesophageal reflux disease (GERD and Hiatus hernia. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done laparoscopically. Laparoscopic surgery, also called Minimally invasive surgery (MIS, bandaid surgery, Keyhole surgery, or pinhole surgery [10]

An obsolete treatment is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. A vagotomy is a surgical procedure that is performed only in humans The vagus nerve (ˈveɪˌgəs (VĀ-gəs (also called pneumogastric nerve or cranial nerve X) is the tenth of twelve paired Cranial nerves, and is the This treatment has been largely replaced by medication.

Other treatments

In 2000 the U. S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. Another, the Stretta Procedure, uses electrodes to apply radio frequency energy to the LES. Stretta procedure is a minimally invasive endoscopic procedure for the treatment of Gastroesophageal reflux disease (GERD The long-term outcomes of both procedures compared to a Nissen fundoplication are still being determined.

Subsequently the NDO Surgical Plicator was cleared by the FDA for endoscopic GERD treatment. The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture-based implant. The Plicator is currently marketed by NDO Surgical, Inc. [1]

Another treatment that involved injection of a solution during endoscopy into the lower esophageal wall was available for about one year ending in late 2005. It was marketed under the name Enteryx. It was removed from the market due to several reports of complications from misplaced injections.

Barrett's esophagus

GERD may lead to Barrett's esophagus, a type of metaplasia which is in turn a precursor condition for carcinoma. Barrett's esophagus (UK Oesophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus or colloquially as Barrett's Metaplasia ( Greek: "change in form" is the reversible replacement of one differentiated Cell type with another mature differentiated cell type The risk of progression from Barrett's to dysplasia is uncertain but is estimated to include 0. 1% to 0. 5% of cases, and has probably been exaggerated in the past. Due to the risk of chronic heartburn progressing to Barrett's, EGD every 5 years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD.

References

  1. ^ DeVault KR, Castell DO (1999). "Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology". Am. J. Gastroenterol. 94 (6): 1434–42. PMID 10364004.  
  2. ^ a b Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". Am. J. Gastroenterol. 102 (10): 2128-2134. doi:10.1111/j.1572-0241.2007.01348.x. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17573791.  
  3. ^ Ayazi S, Crookes P, Peyre C, (2007). "Objective documentation of the link between gastroesophageal reflux disease and obesity". Am. J. Gastroenterol. 102 (S): 138-139.  
  4. ^ Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R (2004). "Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?". Clin. Gastroenterol. Hepatol. 2 (9): 761–8. doi:10.1016/S1542-3565(04)00347-7. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15354276.  
  5. ^ Kasasbeh A, Kasasbeh E, Krishnaswamy G (2007). "Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex--a hypothetical review". Sleep Med Rev 11 (1): 47–58. doi:10.1016/j.smrv.2006.05.001. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17198758.  
  6. ^ a b c d Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16682569.  
  7. ^ Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S (1995). "Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn". Am J Ther 2 (8): 546–552. doi:10.1097/00045391-199508000-00006. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 11854825.  
  8. ^ Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO (1999). "Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease". Am. J. Gastroenterol. 94 (8): 2069–73. doi:10.1111/j.1572-0241.1999.01279.x. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 10445529.  
  9. ^ a b Tran T, Lowry A, El-Serag H (2007). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs". Aliment Pharmacol Ther 25 (2): 143-53. doi:10.1111/j.1365-2036.2006.03135.x. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17229239.  
  10. ^ Abbas A, Deschamps C, Cassivi SD, et al. (2004). "The role of laparoscopic fundoplication in Barrett’s esophagus". Annals of Thoracic Surgery 77 (2): 393-396. doi:10.1016/S0003-4975(03)01352-3. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 14759403.  

External links

"NIH" redirects here For other meanings of NIH see NIH (disambiguation. The Canadian Society of Intestinal Research (CSIR is a national registered charity established in 1976 The Cleveland Clinic (formally known as the Cleveland Clinic Foundation) is a multispecialty academic medical center located in Cleveland, Ohio,
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