Gastroesophageal Reflux Disease
Evaluation
General—a common, chronic condition characterized by heartburn once or more in a month
Clinical:
Classic symptoms → acid regurgitation and heartburn
Atypical symptoms → asthma, chest pain, cough, dental caries, laryngitis, and sore throat
Epidemiology—44% of US adults have heartburn
Risk factors (of complicated gastroesophageal reflux disease [GERD]):
Dysphagia, odynophagia (painful swallowing), bleeding, emesis, decrease in weight, early satiety
Risk factors for Barrett’s esophagus—white, male, aged 45 or older, long-standing symptom duration
Diagnosis
Empiric acid suppression × 4 to 8 weeks for those with typical symptoms and no risk factors
If this resolves the patient’s ailment, then there is no need for a 24-hour pH probe.
For those with possible esophageal complications/Barrett’s, get an esophagogastroduodenoscopy (EGD)
Treatment
Lifestyle modifications
Avoid large meals, acidic foods, alcohol, and caffeine.
Avoid wearing clothing that is too tight around the waist.
Avoid lying down within 4 hours of a meal.
Decrease dietary fat intake and lose weight.
Raise the head of the bed.
Smoking cessation.
Medications (can employ “step-up” or “step-down” therapy; usually treat for 8 weeks)
Antacids—occasional heartburn responds well to antacids
