Gastroesophageal reflux disease

Abstract

Gastroesophageal reflux, when excessive, causes a variety of injuries to the esophagus and adjacent organs: only local injuries to esophagus (gastroesophageal reflux disease-GERD), and their consequences are dealt with here. Discussed is the definition of GERD, diagnosis, epidemiology, pathogensis, natural history, risk factors, management, complications, and how various facets of the disease give rise to disordered deglutition. In dealing with all aspects of GERD, a major emphasis is placed on prevention or reversal of severe disease, key to which is good medical management, not only by pharmacologic therapy, but also by providing the patient with education and insight into anatomical, functional, and lifestyle aspects of their disease, and how any specific adverse risk factors in their particular case can be minimized or abolished. The roles of neuromuscular abnormalities, transient lower sphincter relaxations, hypotensive sphincters, and hiatus hernia, in exposing the esophagus to impaired clearance of a noxious refluxate, with consequent mucosal injury, are summarized. Beyond these, and potentially increasing tissue injury, are numerous additional risk factors, comorbid conditions, and adverse effects of a number of drugs commonly used in treating other illnesses. Existing drug therapies for GERD (antacids, histamine antagonists, proton pump inhibitors, sucralfate) are examined in detail, and emerging pharmacotherapies are briefly reviewed. Endoscopic and surgical therapies are examined elsewhere in this volume.