Gastroesophageal reflux disease

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This article is about Gastroesophageal reflux disease. For other uses of the term Reflux, please see Reflux (disambiguation).

Gastroesophageal reflux disease (GERD) is a condition in which stomach acid repeatedly flows upwards into the esophagus and throat, causing "heartburn" and sometimes sore-throat pain and sinusitis. It is also spelled "Gastrooesophageal reflux disease" (abbreviated GORD) in Britain and Commonwealth countries.


Gastroesophageal reflux disease is a multifactorial disease.[1]

Twin studies suggest a genetic component.[2]


Obesity if associated with gastroesophageal reflux disease.[3][4] Obesity may interfeere with function of the gastroesophageal junction.[5]

Hiatal hernia

The presence of a hiatal hernia correlates with abnormal 24 ph monitoring. In one study the presence of abnormal ph monitoring was:[6]

  • No hernia 18%
  • Hernia < 2cm 27%
  • Hernia > 2cm 35%

Psychological stress

Psychological stress may lead to physiologic abnormalities in the esophagus.[7]


Patients with GERD may have heartburn or reflux symptoms; however, these symptoms may be due to peptic ulcer disease.[8][9]

GERD may be able to exacerbate asthma.[10]

It is unclear whether GERD can cause laryngeal symptoms such as chronic hoarseness.[11][12][13][14]


There is no single test that can identify all patients with GERD. However, most patients with have abnormalities of either 24 hour ph monitoring or the Berstein test.[1]

Response to antisecretory therapy

One study found:[15]

This leads to a negative likelihood ratio of 0.35 which indicates the test, when the patient does not respond to treatment, has some value in excluding the diagnosis of GERD.

Endoscopy may be needed for patients with typical symptoms according to a randomized controlled trial.[16]


Hiatal hernia

The accuracy of a radiologic hiatal hernia predicts abnormal 24 hour ph monitoring is:[6] Hernia of any size:

Hernia at least 2cm:

Reflux on manual stomach compression or valsalva

The accuracy of reflux during the upper gastrointestinal series predicts endoscopic esophagitis is:[17]

Spontaneous reflux:

Reflux during abdominal compression:


Clinical practice guidelines recommend esophagogastroduodenoscopy if:[19]


Avoid tight fitting garments.

  • Eating slower may help.[20]
  • The evidence for most dietary interventions is anecdotal.[21]
  • Positioning. A meta-analysis found that elevating the head of the bed may help.[21]. A subsequent randomized cross-over study showed benefit by avoiding eating two hours before bed.[22] Sleeping in the left lateral decubitus position might help.[23]
  • Weight loss might reduce symptoms.[21][24]


A meta-analysis found that "alginate/antacid combination (Gaviscon) had an absolute benefit increase of 26%(number needed to treat is 4), histamine H2 antagonists had an absolute benefit of 10-12%(number needed to treat is 9), and antacids had an absolute benefit increase 8% (number needed to treat is 12)."[25]

Regarding proton pump inhibitor medications, systematic reviews by the Cochrane Collaboration and Clinical Evidence concluded "PPI therapy is the most effective therapy in oesophagitis but H2RA therapy is also superior to placebo."[26][27] PPIs may be taken 'on-demand' for nonerosive GERD and continuous therapy for erosive GERD.[28]

Regarding prokinetic medications, systematic reviews by the Cochrane Collaboration and Clinical Evidence concluded "There is a paucity of evidence on prokinetic therapy but no evidence that it is superior to placebo."[26][27]

Although PPIs are the most effective individual drug, adding cisapride may give further benefit.[29] Cisapride is no longer on the market due to cardiac adverse drug reactions.

Reducing medications

Some patients will be able to take 2-4 week course of medications as needed.[30]

15% of patients may be able to stop medications after symptoms are controlled.[31]

Stopping medications may lead to transient rebound hypersecretion of acid.[32]


Laparoscopic fundoplication may be better than medical therapy at reducing chronic symptoms.[33]


Patients with reflux symptoms are at a small increased risk of Barrett esophagus.[34]


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