Gastroesophageal Reflux Disease (GERD) Overview

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Gastroesophageal Reflux Disease (GERD) Overview

Contents

Overview
Treatment
Lifestyle Modifications
Evaluation
Pharmacological Therapy
Antireflux Surgery
Patient Education
Guideline References

Overview

  • Gastroesophageal reflux disease (GERD) is a disorder in which gastric contents recurrently reflux into the esophagus, causing troublesome symptoms &/or complications, eg injury of the esophageal mucosa & adjacent structures
    • Symptoms become “troublesome” when they adversely affect a patient’s well-being
  • Produced by various mechanisms such as frequent occurrence of transient relaxation of the lower esophageal sphincter (LES), pressure abnormalities in the lower esophageal sphincter (which can be caused by hormonal & neural mediators, food, drugs & patient lifestyle)
    • Other factors in the pathology of GERD include poor esophageal clearance, delayed gastric emptying time, hiatal hernia
  • Typical symptoms are acid regurgitation & heartburn
    • Regurgitation is the perception of flow of refluxed gastric contents into the mouth or hypopharynx
    • Heartburn is defined as a burning sensation in the retrosternal region
  • Other presenting symptoms include, nausea, chest pain, epigastric pain, belching, early satiety
    • Non-cardiac chest pain (NCCP) is common among Asian patients & may be a presenting feature of GERD
  • Based on symptomatology, GERD manifestations are divided into the esophageal syndromes (esophageal symptomatic syndromes or esophageal syndromes w/ esophageal injury) or extraesophageal syndromes w/ established or proposed associations
  • Based on endoscopic findings, GERD could be an erosive reflux disease (ERD) or a non-erosive reflux disease (NERD)

Refer to Symptoms for more information

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Treatment

  • Management of GERD includes medical treatment w/ empiric therapy proton pump inhibitors (PPIs) or histamine2-receptor antagonists (H2RAs) - Surgery may be done if patient fails medical management
    • Adjunctive pharmacotherapy includes antacids & alginates or propulsives/prokinetic agents
  • Surgery may be done if patient fails medical management

Refer to Treatment for more information on Pharmacological Therapy & Antireflux Surgery

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Lifestyle Modifications

  • All patients should be educated regarding factors that may worsen their GERD symptoms but lifestyle modifications alone typically do not provide adequate relief for most GERD patients
  • Advice should be tailored to the circumstances of the individual patient

Refer to Patient Education for more information

Below is the overview of disease management of Gastroesophageal Reflux Disease:

overview of management of gastroesophageal reflux disease GERD

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Gastroesophageal Reflux Disease Symptomsâ–¶

 

Version: 2 Oct 2015 

Guideline References:

  1. Armstrong D, Marshall JK, Chiba N, et al. Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults - update 2004. Can J Gastroenterol. 2005 Jan;19(1):15-35. PMID: 15685294
  2. Dent J, Jones R, Kahrilas P, et al. Management of gastro-esophageal reflux disease in general practice. BMJ. 2001 Feb;322(7282):344-347. PMID: 11159660
  3. DeVault KR, Castell DO, American College of Gastroenterology. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005 Jan;100(1):190-200. PMID: 15654800
  4. Fock KM, Talley N, Hunt R, et al. Report of the Asia-Pacific consensus on the management of gastroesophageal reflux disease. J Gastroenterol Hepatol. 2004 Apr;19(4):357-367. PMID: 15012771
  5. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-328. doi: 10.1038/ajg.2012.444. Accessed 18 Jul 2013. PMID: 23419381
  6. New Zealand Guidelines Group. Management of dyspepsia and heartburn: evidence-based practice guideline. http://www.health.govt.nz/publication/management-dyspepsia-and-heartburn. Jun 2004
  7. Pharmacy Benefits Management Strategic Healthcare Group and the Medical Advisory Panel Veterans Health Administration Department of Veterans Affairs. VHA/DoD clinical practice guideline for the management of adults with gastroesophageal reflux disease in primary care practice. http://www.guideline.gov/content.aspx?id=15706&search=Chronic+obstructive+asthma%2c+with+acute+exacerbation. Mar 2003
  8. Poh J. Restrictions on the use of metoclopramide-containing products. Drug safety information no. 57. Health Sciences Authority (HSA). http://www.hsa.gov.sg/content/hsa/en/Health_Products_Regulation/Safety_Information_and_Product_Recalls/Dear_Healthcare_Professional_Letters/2015/restrictions-on-theuseofmetoclopramidecontainingproducts.html. 23 Jul 2015.
  9. Sollano JD, Romano RP, Ibanez-Guzman L, et al. Clinical practice guidelines on the diagnosis and treatment of gastroesophageal reflux disease (GERD). Philippine Journal of Internal Medicine. 2015 Jul-Sep;53(3):1-17. http://www.pcp.org.ph/files/PJIM%20Vol53%20No3/Clinical_Practice_Guidelines_on_the_Diagnosis_and_Treatment_of_Gastroesophageal_Reflux_Disease_GERD.pdf. Accessed 02 Oct 2015.
  10. Vakil N, van Zanten SV, Kahrilas P, et al; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006 Aug;101(8):1900-1920. PMID: 16928254