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BMJ Best Practice

Gastroesophageal reflux disease

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Last updated:November  2019November  2019
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Summary

Diagnosis is clinical. A therapeutic trial of a proton-pump inhibitor (PPI) can serve for both diagnosis and for 1 last update 2020/06/05 initial treatment.Diagnosis is clinical. A therapeutic trial of a proton-pump inhibitor (PPI) can serve for both diagnosis and initial treatment.

Upper endoscopy is indicated to evaluate for complications; for atypical, persistent, or relapsing symptoms; or for alarm features (e.g., weight loss, anemia).

High rate of relapse upon stopping treatment.

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Heartburn Remedies Best Home Remedies (🔥 Remedies) | Heartburn Remedies Causeshow to Heartburn Remedies for The American College of Gastroenterology defines gastroesophageal reflux disease (GERD) as "symptoms or complications resulting from the reflux of gastric contents into the esophagus or beyond, into the oral cavity (including larynx) or lung".[1]Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28. http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/ http://www.ncbi.nlm.nih.gov/pubmed/23419381?tool=bestpractice.com

Typical symptoms are heartburn and acid regurgitation. Extraesophageal symptoms include cough, laryngitis, asthma, or dental erosion. Atypical symptoms include dyspepsia, epigastric pain, nausea, bloating, and belching.[1]Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28. http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/ Heartburn Remedies Quick Relief (🔴 Diet For) | Heartburn Remedies How To Get Rid Ofhow to Heartburn Remedies for http://www.ncbi.nlm.nih.gov/pubmed/23419381?tool=bestpractice.com

GERD may occur with or without esophageal inflammation (esophagitis). If erosions are present on endoscopic examination, the condition is called erosive reflux disease (ERD); if there are no erosions, it is called nonerosive reflux disease (NERD).[1]Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28. the 1 last update 2020/06/05 http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/ http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/ for 1 last update 2020/06/05 http://www.ncbi.nlm.nih.gov/pubmed/23419381?tool=bestpractice.com http://www.ncbi.nlm.nih.gov/pubmed/23419381?tool=bestpractice.com

The American Gastroenterological Association definition of GERD follows the Montreal criteria.[2]Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006 Aug;101(8):1900-20. http://www.ncbi.nlm.nih.gov/pubmed/16928254?tool=bestpractice.com [3]Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008 Oct;135(4):1383-91 http://www.gastrojournal.org/article/S0016-5085%2808%2901606-5/fulltext Heartburn Remedies Heartburn Home Remedies (☑ 9 Natural Remedies) | Heartburn Remedies 10 Foodshow to Heartburn Remedies for http://www.ncbi.nlm.nih.gov/pubmed/18789939?tool=bestpractice.com The definition is reflux of stomach contents causing troubling symptoms that affect wellbeing or that cause complications.

History and exam

Key diagnostic factors

  • heartburn
  • acid regurgitation

Other diagnostic factors

  • dysphagia
  • bloating/early satiety
  • laryngitis
  • globus
  • enamel erosion
  • halitosis
  • dyspepsia

Risk factors

  • family history of heartburn or GERD
  • older age
  • hiatal hernia
  • obesity
  • lower esophageal sphincter (LES) tone-reducing drugs
  • psychological stress
  • asthma
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • smoking
  • alcohol consumption
  • peroral endoscopic myotomy (POEM)
  • dietary factors

Diagnostic investigations

1st investigations to order

  • proton-pump inhibitor trial
Full details

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  • esophagogastroduodenoscopy (EGD)
  • ambulatory pH monitoring
  • esophageal manometry
  • combined impedance-pH testing
  • barium swallow
  • esophageal capsule endoscopy
Full details

Treatment algorithm

Contributors

Professor of Medicine

Chief of Division of Gastroenterology

Texas Tech University Health Sciences Center

El Paso

TX

Disclosures

Heartburn Remedies Heartburn Relief (👍 Heartburn Treatments) | Heartburn Remedies 11 Foods That Helphow to Heartburn Remedies for MJZ has been a speaker for Synergy Pharmaceuticals and for Allergan Pharmaceuticals. He is an author of a reference cited in this topic.

Heartburn Remedies Heartburn Relief (☑ Best Home Remedies) | Heartburn Remedies Foods To Avoidhow to Heartburn Remedies for Assistant Professor of Clinical Medicine

Division of Gastroenterology and Hepatology

University of Miami

Miami

FL

Disclosures

AFC declares that he has no competing interests.

Dr Marc J. Zuckerman and Dr Andres F. Carrion would like to gratefully acknowledge Dr. Sheila Feit and Dr. Mohamed Othman, previous contributors to this topic.

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Professor of Medicine

Chief the 1 last update 2020/06/05 of GI EndoscopyChief of GI Endoscopy

Rikshospitalet University Hospital

for 1 last update 2020/06/05 OsloOslo

Norway

Disclosures

LA declares that he has no competing interests.

Consultant

Department of Internal Medicine

Copenhagen University Hospital

Hellerup

Denmark

Disclosures

LLG declares that she has no competing interests.

Professor of Medicine

Department of Gastroenterology & Hepatology

Center for Swallowing & Esophageal Disorders

Cleveland Clinic

Cleveland

OH

Disclosures

GWF has received fees from: Astra Zeneca (consultant, speakers bureau, grant support); Takeda (grant support); Pentax (speaker, travel); Wyeth (consultant); and C2 Therapeutics (consultant).

Use of this for 1 last update 2020/06/05 content is subject to our disclaimerUse of this content is subject to our disclaimer

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