gastrointestinal disorders
Gastroesophageal Reflux Disease (GERD)
Key Points
Lower esophageal sphincter incompetence and transient relaxations allow gastric contents to reflux into the esophagus and rarely into the larynx or lungs. Complications include esophagitis, esophageal stricture, Barrett esophagus, and esophageal adenocarcinoma. The main symptom in adults is heartburn, and infants present with vomiting, irritability, anorexia, and sometimes symptoms of chronic aspiration; at any age, chronic aspiration may cause cough, hoarseness, or wheezing. Diagnose clinically; do endoscopy in patients not responding to empiric treatment and consider advanced pH monitoring if endoscopy is normal in patients with typical symptoms. Treat with lifestyle changes (eg, head of bed elevation, weight loss, dietary trigger avoidance) and acid-suppressing therapy. Antireflux surgery can help patients with severe esophagitis, complications of esophagitis, intolerance to drug therapy, or a large amount of symptomatic nonacid reflux. 