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- Gastroesophageal reflux disease (GERD) is a condition that develops when there is a retrograde flow of stomach contents back into the esophagus. It can present as non-erosive reflux disease or erosive esophagitis.
www.ncbi.nlm.nih.gov › books › NBK441938Gastroesophageal Reflux Disease - StatPearls - NCBI Bookshelf
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Jul 3, 2023 · Gastroesophageal reflux disease (GERD) is a condition that develops when there is a retrograde flow of stomach contents back into the esophagus. It can present as non-erosive reflux disease or erosive esophagitis.
- Catiele Antunes, Abdul Aleem, Sean A. Curtis
- 2023/07/03
- 2019
- Prognosis
- Society and culture
- Mechanism
- Contraindications
- Clinical significance
- Mechanism of action
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- Epidemiology
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INTRODUCTION Despite treatment with proton pump inhibitors (PPIs), some patients with gastroesophageal reflux disease (GERD) continue to have reflux symptoms or endoscopic evidence of esophagitis. This topic will review an approach to patients with refractory GERD. The clinical manifestations, diagnosis, and initial medical management of GERD are ...
TERMINOLOGY The definition of refractory gastroesophageal reflux disease (GERD) is controversial [1]. According to most experts, patients with GERD who exhibit partial or lack of response to proton pump inhibitor (PPI) twice daily are considered to have failed PPI therapy [2]. GERD in these patients is termed refractory GERD. However, we suggest t...
Insufficient acid suppression A range of mechanisms can result in insufficient suppression of gastric acid.
Medication timing and adherence Poor compliance with proton pump inhibitor (PPI) timing and adherence is an important cause for inadequate acid suppression and refractory GERD [9-11]. PPIs should be administered 30 to 60 minutes before breakfast for maximal inhibition of proton pumps. In one study that included 100 patients with GERD, only 46 perc...
Differences in PPI metabolism PPIs are metabolized through the hepatic cytochrome system, with CYP2C19 having the dominant role. The activity of CYP2C19 is determined to some extent by a genetic polymorphism. Approximately 5 percent of Caucasian patients and >10 percent of Asians, are homozygous for a CYP2C19 mutation (ie, slow metabolizers), pote...
The presence of concentrated, highly acidic gastric juice postprandially at the gastroesophageal junction, termed the acid pocket, likely has a limited role in refractory GERD by causing re-reflux of gastric acid. A study that included 18 patients with GERD, of whom nine had a partial response to PPIs, demonstrated no difference in the pH or positi...
Weakly acidic or alkaline reflux (non-acid reflux) Non-acid reflux episodes primarily occur in the postprandial period as transient lower esophageal sphincter relaxation occurs more frequently following meal-induced gastric fundus distension. In patients on PPIs, treatment changes the acidity of the refluxate but does not decrease the volume of re...
There are limited data on the prevalence of reflux hypersensitivity. In a study of 329 patients with non-erosive reflux disease who underwent pHimpedance monitoring, 40 percent had abnormal acid exposure. The prevalence of reflux hypersensitivity and functional heartburn were 36 and 24 percent, respectively [24].
According to the Rome IV criteria, a diagnosis of reflux hypersensitivity requires all of the following criteria be fulfilled for the last three months with symptom onset at least six months prior to the diagnosis [25]: According to the Rome IV criteria, a diagnosis of functional heartburn requires all of the following criteria be fulfilled for the...
Esophageal hypersensitivity is analogous to the visceral hyperalgesia described in other functional gastrointestinal disorders (eg, functional chest pain, functional dyspepsia) and is driven by similar mechanisms of altered central processing of visceral stimuli, altered autonomic activity, and psychological abnormalities. (See \"Evaluation of the ...
In addition, we perform blood count to identify patients with iron deficiency anemia, if not recently performed. (See 'Alarm features' below.)
DIAGNOSTIC STRATEGIES AND INITIAL MANAGEMENT The timing and extent of diagnostic evaluation in a patient with refractory gastroesophageal reflux disease (GERD) is based on the type of ongoing symptoms and the presence of alarm features. A suggested approach to the management of patients who have failed once daily proton pump inhibitors (PPI) thera...
General measures Lifestyle and dietary modification, and compliance with PPI therapy should be reinforced. Patients should be instructed to take a PPI 30 minutes before a meal. Lifestyle and dietary modification include avoidance of identified dietary triggers, weight loss for patients who are overweight or have had recent weight gain, elevation o...
Optimize PPI therapy In patients with reflux symptoms despite standard dose once daily PPI (eg, omeprazole 40 mg once daily), options include splitting the dose (eg, omeprazole 20 mg twice daily), doubling the PPI dose (eg, omeprazole 40 mg twice daily), or switching to another PPI (eg, lansoprazole 30 mg once daily). When splitting or doubling th...
We usually double the PPI dose for eight weeks before considering an alternative PPI. In one study, doubling the PPI dose in patients with symptomatic GERD, despite once daily PPI therapy, increased the rate of overall symptom improvement by 22 to 26 percent [38,39]. However, both options appear to be effective in controlling heartburn [38,40]. In ...
Pain modulators have been shown to improve esophageal pain in patients with other functional esophageal disorders such as functional chest pain of esophageal origin. However, evidence of their efficacy in patients with reflux hypersensitivity and functional heartburn are limited given the lack of randomized trials [56-59]. In a randomized trial tha...
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on \"patient info\" and the keyword(s) of interest.) SUMMARY AND RECOMMENDATIONS
May 1, 2024 · Gastroesophageal reflux disease (GERD) is a condition in which there is a retrograde flow of the stomach contents into the esophagus or beyond into other regions such as oral cavity, larynx, or the lungs, primarily resulting in inflammation of the esophageal mucosa.
- 2024/05/01
Jul 21, 2022 · Reflux esophagitis (RE) / gastroesophageal reflux disease (GERD) is the reflux of gastric contents into the esophagus that results in symptoms or complications; reflux esophagitis / gastroesophageal reflux disease is objectively defined as mucosal injury seen at endoscopy or abnormal esophageal acid exposure on a reflux monitoring study.
Sep 28, 2022 · Gastroesophageal reflux disease (GERD) is a condition in which the reflux of stomach contents causes troublesome symptoms and complications. 1 In population-based studies, mild symptoms that...
Gastroesophageal reflux disease (GERD) is a common clinical problem, affecting millions of people worldwide. Patients are recognized by both classic and atypical symptoms. Acid suppressive therapy provides symptomatic relief and prevents complications in many individuals with GERD.
The pathogenesis of gastroesophageal reflux disease (GERD) is complex and involves changes in reflux exposure, epithelial resistance, and visceral sensitivity. The gastric refluxate is a noxious material that injures the esophagus and elicits symptoms.
