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Source: May D, Thiman M, Rao SCS. Gastroesophageal reflux disease. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=135145538. Accessed March 27, 2017.
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CONDITION/DISORDER SYNONYMS
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Heartburn.
Acid reflux disease.
GERD
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Defective lower esophageal sphincter (LES) pressure or function.
Abnormal esophageal anatomy.
Improper esophageal clearance of gastric fluids.
Reduced mucosal resistance to acid.
Delayed or ineffective gastric emptying.
Reduced salivary buffering of acid.
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Decreased LES pressure may result from spontaneous transient LES relaxations, transient increases in intraabdominal pressure, atonic LES, or ingestion of certain foods and medications.
Substances that promote esophageal damage upon reflux include gastric acid, pepsin, bile acids, and pancreatic enzymes.
Composition and volume of refluxate and duration of exposure are most important factors in determining clinical consequences.
Complications from long-term acid exposure include esophagitis, esophageal strictures, Barrett esophagus, and esophageal adenocarcinoma.
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Most common in persons older than 40 years.
20% of adults in Western countries suffer from GERD symptoms on weekly basis.
Prevalence of GERD highest in Western countries.
No difference in incidence between men and women, except for higher incidence during pregnancy.
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CLINICAL PRESENTATION
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Heartburn (substernal sensation of warmth or burning rising up from abdomen that may radiate to neck), water brash (hypersalivation), belching, regurgitation.
Pain may wax and wane and be aggravated by activities that worsen reflux (eg, recumbent position, bending over, or high-fat meals).
Extraesophageal symptoms may include chronic cough, laryngitis, asthma, and dental enamel erosion.
Alarm symptoms include dysphagia, odynophagia, and unexplained weight loss.
Tissue injury-based GERD (with or without symptoms) may present with esophagitis, esophageal strictures, Barrett esophagus, or esophageal carcinoma.
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MEANS OF CONFIRMATION AND DIAGNOSIS
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Clinical history, including symptoms and risk factors.
Patients with mild, typical symptoms do not usually require invasive evaluation.
Clinical diagnosis can be assumed in patients who respond to appropriate therapy.
Perform diagnostic tests in patients who do not respond to therapy or who present with alarm symptoms.
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DIAGNOSTIC PROCEDURES
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Endoscopy preferred for assessing mucosa for esophagitis, identifying Barrett esophagus, and diagnosing complications.
Camera-containing capsule swallowed by patient can visualize esophageal mucosa.
Ambulatory pH monitoring helps ...