GERD Overview and Extraesophageal Symptoms

Overview of GERD

• Gastroesophageal reflux disease (GERD) occurs due to gastric contents reaching the esophagus, causing both esophageal symptoms and extraesophageal issues.
• Extraesophageal symptoms include hoarseness, cough, wheezing, and asthma.

Risk Factors

• Established risk factors include increased body mass index (BMI), tobacco smoking, and genetic predisposition.
• Higher BMI correlates with a greater risk of GERD, with obesity significantly increasing susceptibility.

Esophagogastric Junction Dysfunction

• GERD is characterized by dysfunction at the esophagogastric junction, including ineffective lower esophageal sphincter function, increasing regurgitation of acidic contents.
• Normal transient lower esophageal sphincter relaxation can become problematic if prolonged or frequent.

Prevalence and Demographics

• In North America, GERD prevalence is around 15.4%, varying by age.
• Almost 50% of newborns experience regurgitation, resolving in 90% by age one, but prevalence increases again during adolescence and adulthood.

Symptoms

• Cardinal symptoms include heartburn and acid regurgitation, with chest pain being common.
• Atypical symptoms may include dysphagia, chronic cough, asthma exacerbations, and dental erosion.

Complications

• Esophagitis, affecting 18% to 25% of GERD patients, is the most common complication characterized by mucosal inflammation and erosions.
• Barrett esophagus is a concerning condition that can develop due to chronic GERD, leading to an increased risk of esophageal adenocarcinoma.

Treatment Guidelines

• Lifestyle modifications recommended: weight loss, smoking cessation, and elevation of the head of the bed.
• Proton pump inhibitors (PPIs) are the first-line treatment, more efficacious than histamine-2 receptor antagonists.
• Initial treatment involves once-daily PPI for 4-8 weeks, with a preference for the lowest effective maintenance dose thereafter.
• For inadequate response, consider twice-daily PPIs or histamine-2 receptor antagonists.

Clinical Recommendations

• Screening for Barrett esophagus is not routinely recommended but may be considered for high-risk individuals.
• Continuous PPI therapy is advisable for patients with Barrett esophagus to prevent progression to cancer.

Safety and Long-term Considerations

• Long-term PPI use may be linked to potential adverse effects, including kidney disease, infections, osteoporosis, and gastric cancer.
• PPIs are generally safe for pregnant patients.

Summary of Treatment Outcomes

• Effective PPI therapy typically alleviates GERD symptoms and aids in healing erosive esophagitis, with regular monitoring advised for long-term management.

GERD Overview

• Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus.
• Symptoms can extend beyond the esophagus, affecting the pharynx, mouth, larynx, and airways, leading to hoarseness, wheezing, cough, and asthma.

Risk Factors

• Established risk factors include:
  • Increased body mass index (BMI)
  • Tobacco smoking
  • Genetic predisposition
• Obesity is linked to a higher risk of developing GERD.

Esophagogastric Junction Dysfunction

• GERD involves dysfunction at the esophagogastric junction, specifically loss of lower esophageal sphincter (LES) function.
• Normal transient LES relaxation can lead to GERD if excessive.

Prevalence and Age-Related Trends

• GERD prevalence is age-dependent:
  • Nearly 50% of newborns experience regurgitation, resolving in 90% by age 1.
  • The prevalence rises again in adolescence and continues to increase in older adults.

Symptoms

• Cardinal symptoms include:
  • Heartburn
  • Acid regurgitation
  • Common chest pain
• Atypical symptoms may include:
  • Dysphagia
  • Chronic cough
  • Asthma
  • Chronic laryngitis
  • Hoarseness

Complications

• Esophagitis (inflammation of the esophagus) occurs in 18% to 25% of GERD patients, detectable via endoscopy and classified by the Los Angeles system.
• Barrett esophagus, a precursor to esophageal adenocarcinoma, can develop as a result of GERD.

Treatment Guidelines

• General recommendations include:
  • Weight loss for overweight or obese individuals.
  • Elevating the head of the bed for certain patients.
  • Lifestyle modifications, including healthy eating and smoking cessation.
• Proton pump inhibitors (PPIs) are the most effective treatment, outperforming histamine2 receptor antagonists and placebo.
• Initial PPI therapy should last for 4 to 8 weeks, with adjustments based on patient response.
• If patients do not respond to PPIs, further evaluation with pH and impedance monitoring may be necessary.

Pharmacologic Management

• PPIs work by irreversibly inhibiting hydrogen-potassium ATPase, reducing stomach acidity and alleviating GERD symptoms.
• Current clinical guidelines suggest an initial standard-dose PPI for those with typical symptoms for 4 weeks, with prolonged therapy if endoscopy-verified erosive esophagitis is present.

Atypical Presentations and Emerging Concerns

• GERD patients may exhibit atypical presenting symptoms, including:
  • Dyspepsia
  • Nausea
  • Bloating
  • Belching
• Long-term PPI treatment may be associated with potential adverse events, such as kidney disease, infections, osteoporosis, and gastric cancer concerns.

This quiz explores gastroesophageal reflux disease (GERD), its symptoms, and related conditions. Discover the risk factors for GERD and how gastric contents can affect areas beyond the esophagus, including the pharynx and respiratory system. Test your understanding of this common yet complex condition.