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  • The need for lifestyle modifications that may alleviate GERD should be assessed during each encounter with a patient.

  • MTM providers should evaluate medications for GERD at each encounter, specifically assessing efficacy, need for continued therapy (ie, the patient should be taking the lowest effective dose for symptom relief), and potential adverse effects.

  • MTM providers should educate patients on the importance of watching for alarm symptoms of GERD and when to seek medical attention.


Almost 1 in 5 adults in the United States has troublesome symptoms of heartburn or regurgitation at least once weekly. These symptoms are referred to as gastroesophageal reflux disease or GERD.1 GERD is a condition that develops when the reflux of stomach contents causes troublesome symptoms or complications. While most cases are not serious, symptoms are considered to be "troublesome" if they adversely affect an individual's well being. Episodic heartburn that is not frequent or painful enough for a patient to consider it to be bothersome is not included in the definition of GERD.2, 3 Table 23-1 highlights definitions and common abbreviations associated with GERD.

Table 23-1.Common GERD Definitions and Abbreviations

A key feature in the development of GERD is abnormal reflux. Gastric contents from the stomach enter the esophagus, irritating its lining and causing symptoms. For some patients, other factors, including defective lower esophageal sphincter (LES) pressure or function, contribute to presentation of symptoms. Other pathophysiological features can further lead to presentation of GERD symptoms; these and other factors are highlighted in Table 23-2. Additionally, endogenous substances produced by the body can promote esophageal damage upon flow back into the esophagus. These include gastric acid, pepsin, bile acids, and pancreatic enzymes. The composition and volume of the refluxate, as well as duration of exposure, are all aggravating factors that play a role in damaging the lining of the esophagus and causing symptoms and complications of GERD and associated syndromes (Table 23-3).2

Table 23-2.Secondary Causes and Contributing Factors that Worsen Symptoms of GERD2

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