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Gastroesophageal Reflux Disease

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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the underlying causes of gastroesophageal reflux disease (GERD).

  2. Differentiate among typical, atypical, and complicated symptoms of GERD.

  3. Determine which diagnostic tests should be recommended based on the patient's clinical presentation.

  4. Identify the desired therapeutic outcomes for patients with GERD.

  5. Recommend appropriate lifestyle modifications and pharmacotherapy interventions for patients with GERD.

  6. Discuss other nonpharmacologic interventions that may be appropriate for patients with GERD.

  7. Formulate a monitoring plan to assess the effectiveness and safety of pharmacotherapy for GERD.

  8. Educate patients on appropriate lifestyle modifications and drug therapy issues including compliance, adverse effects, and drug interactions.

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KEY CONCEPTS

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  • Image not available. Esophageal gastroesophageal reflux disease (GERD) syndromes can be divided into two distinct categories: (a) symptomatic esophageal syndromes and (b) syndromes associated with esophageal tissue injury.

  • Image not available. Patients with GERD may display symptoms described as: (a) typical, (b) atypical, or (c) complicated.

  • Image not available. Patients presenting with uncomplicated typical symptoms of reflux (heartburn and regurgitation) do not usually require invasive esophageal evaluation.

  • Image not available. The goals of treatment of GERD are to alleviate symptoms, decrease the frequency of recurrent disease, promote healing of mucosal injury, and prevent complications.

  • Image not available. Treatment for GERD involves one or more of the following modalities: (a) patient-specific lifestyle changes and patient-directed therapy, (b) pharmacologic intervention primarily with acid-suppressing agents, (c) antireflux surgery, or (d) endoscopic therapies.

  • Image not available. Acid-suppressing therapy is the mainstay of GERD treatment and should be considered for anyone not responding to lifestyle changes and patient-directed therapy after 2 weeks.

  • Image not available. Antireflux surgery or endoscopic therapies offer an alternative treatment for refractory GERD or when pharmacologic management is undesirable.

  • Image not available. Many patients with GERD experience relapse if medication is withdrawn, and long-term maintenance treatment may be required in these patients.

  • Image not available. Patient medication profiles should be reviewed for drugs that may aggravate GERD.

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INTRODUCTION

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Gastroesophageal reflux disease (GERD) is defined as troublesome symptoms and/or complications caused by refluxing the stomach contents into the esophagus.1,2 The key is that these troublesome symptoms adversely affect the well-being of the patient.2 Image not available. Esophageal GERD syndromes can be divided into two distinct categories: (a) symptomatic esophageal syndromes and (b) syndromes associated with esophageal tissue injury.2 Symptomatic (or symptom-based) esophageal syndrome is associated with severe reflux symptoms with normal endoscopic findings. Syndromes associated with esophageal tissue injury include erosive esophagitis, strictures, Barrett's esophagus, and esophageal adenocarcinoma. Erosive esophagitis occurs when the esophagus is repeatedly exposed to refluxed material for prolonged periods. The inflammation that occurs progresses to erosions of the squamous epithelium.

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Barrett's esophagus is a complication of GERD, characterized by replacement of the normal squamous epithelial lining of the esophagus by specialized columnar-type epithelium. Barrett's esophagus is more likely to occur in patients with a long history (years) of reflux and may be a risk factor for developing adenocarcinoma of the ...

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