54. Gastro-esophageal reflux disease

Page created on September 16, 2021. Not updated since.


For introduction and etiology of GERD, refer to the corresponding pathology 2 topic. For surgical treatment, refer to the corresponding surgery topic.

Clinical features

The typical symptoms of GERD are heartburn and regurgitation. Atypical symptoms may occur if the regurgitation reaches the larynx, bronchi, or teeth, causing symptoms like hoarseness and coughing.

In complicated GERD the patient may have strictures or oesophagitis, which may cause dysphagia or odynophagia, or frank pain.

Diagnosis and evaluation

In most cases, patients don’t need to undergo procedures for the precise diagnosis. If a patient with typical symptoms presents without being at risk of complications, the patient can undergo a so-called PPI test. The patient is prescribed a PPI for 4 weeks, and if the symptoms improve, then the diagnosis of GERD is likely.

In cases where the diagnosis is uncertain, proper diagnostic modalities are necessary. There are many options:

  • Upper endoscopy (first choice)
  • Oesophageal manometry
  • 24-hour oesophageal pH measurement
  • Impedance measurement
  • Bilitec


Treatment involves lifestyle changes such as smoking cessation, weight loss, not eating before bedtime, elevating the head in the bed.

In most cases, medical therapy is necessary. The standard treatment is PPIs. Alternatives include H2 receptor antagonists, antacids, and surface agents like sucralfate.


  • Erosive reflux disease
  • Barrett oesophagus, oesophageal carcinoma

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45. Congenital adrenal hyperplasia. Osteoporosis

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56. Peptic ulcer disease. Helicobacter pylori infection

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Internal medicine

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