Gastroesophageal Reflux Disease

Abstract

astroesophageal reflux disease (GERD) is defined by its cardinal symptoms (recurrent and troublesome heartburn and regurgitation) or by its specific complications (esophagitis, peptic strictures, and Barrett esophagus). 1 Barrett esophagus is a columnar metaplasia replacing parts of the native squamous cell epithelium that can progress to esophageal adenocarcinoma. 2 GERD can be a serious problem and should not be confused with less severe disease such as gastritis or the very common symptoms of dyspepsia or regurgitation that occur in almost all individuals without any underlying gastrointestinal pathology. GERD is caused by gastric contents' reaching the esophagus. Except for causing esophageal symptoms or complications, gastric juices can also reach more proximally (ie, into the pharynx, mouth, larynx, and airways) and cause or worsen various extraesophageal symptoms and conditions such as hoarseness, wheezing, cough, and asthma. 1 Established risk factors for developing GERD include increased body mass index, tobacco smoking, and genetic predisposition, 3 whereas infection with the gastric bacterium Helicobacter pylori can decrease this risk. 4 The prevalence of GERD is high and increasing, with greater rates in high-income countries (15%-25%) than in most low-and middle-income countries (<10%). 2,5 GERD can result in diminished health-related quality of life, and its prevalence and need for longterm treatment can consume substantial health care resources and result in high costs to society. 6,7 This review provides an update of the current evidence regarding GERD, with an emphasis on its clinical management in adults.IMPORTANCE Gastroesophageal reflux disease (GERD) is defined by recurrent and troublesome heartburn and regurgitation or GERD-specific complications and affects approximately 20% of the adult population in high-income countries.OBSERVATIONS GERD can influence patients' health-related quality of life and is associated with an increased risk of esophagitis, esophageal strictures, Barrett esophagus, and esophageal adenocarcinoma. Obesity, tobacco smoking, and genetic predisposition increase the risk of developing GERD. Typical GERD symptoms are often sufficient to determine the diagnosis, but less common symptoms and signs, such as dysphagia and chronic cough, may occur. Patients with typical GERD symptoms can be medicated empirically with a proton pump inhibitor (PPI). Among patients who do not respond to such treatment or if the diagnosis is unclear, endoscopy, esophageal manometry, and esophageal pH monitoring are recommended. Patients with GERD symptoms combined with warning symptoms of malignancy (eg, dysphagia, weight loss, bleeding) and those with other main risk factors for esophageal adenocarcinoma, such as older age, male sex, and obesity, should undergo endoscopy. Lifestyle changes, medication, and surgery are the main treatment options for GERD. Weight loss and smoking cessation are often useful. Medication with a PPI is the most common treatment, and after initial full-dose therapy, w...

Study on the Value of C1q in the Diagnosis of Esophageal Cancer

“…The common treatments were chemotherapy, chemoradiotherapy and surgical resection [15,16] . Reflux disease is associated with an increased risk of esophagitis, esophageal strictures, Barrett esophagus, and esophageal adenocarcinoma, and it has the similar symptoms to EC [17,18] . Using endoscopy can distinguish EC from reflux disease, though some patients refuse this way to check their esophagus [19] .As a result, a blood biomarker which can help to diagnose EC from reflux disease come to be important.…”

Excess Body Weight and Gastroesophageal Reflux Disease

“…Nevertheless, the US Food and Drug Administration (FDA) has issued several safety announcements urging health care professionals to perform reasonable risk-benefit considerations when prescribing PPI [25].…”

Cancer Prevention in Patients with GERD and Barrett’s Esophagus—Medicine

“…32 Amongst antisecretory drugs, PPIs are superior to H 2 RAs in both symptom relief and healing of esophagitis and are now considered the standard of care. [33][34][35] Indeed, H 2 RAs have a relatively short duration of action and, depending on the individual agent and whether the patient is in a fed or fasting state, suppress acid for approximately 4 to 8 hours. Consequently, multiple daily doses of these agents are required.…”