Gastroesophageal Reflux Disease (GERD)

• Gastroesophageal reflux is both a normal physiologic phenomenon that occurs in the general population and a pathophysiologic phenomenon that can result in mild to severe symptoms. Gastroesophageal reflux disease (GERD) can be described as any symptomatic clinical condition or change in tissue structure that results from the reflux of stomach or duodenal contents into the esophagus.
• Heartburn, a burning sensation or discomfort behind the breastbone or sternum, is the most common symptom of GERD. It may be accompanied by regurgitation of gastric contents into the mouth or the lungs. In patients with significant GERD, dysphagia is common and may be a sign of the formation of a stricture in the esophagus. Pulmonary manifestations such as asthma, coughing, or intermittent wheezing and vocal cord inflammation with hoarseness occur in some patients.
• Complications of GERD include esophageal erosion, esophageal ulcer, and esophageal stricture; replacement of normal esophageal epithelium with abnormal (Barrett's) epithelium; and pulmonary aspiration. The majority of patients with GERD will have a normal esophagus upon endoscopy. A physician can diagnose and evaluate the severity of GERD.
• Most episodes of GERD occur during the day, usually after eating; some sufferers also experience reflux during sleep. Nocturnal reflux is commonly associated with a higher risk and a higher degree of esophagitis: acid remains in the esophagus for prolonged periods because there is less swallowing and less saliva produced to neutralize the acid. The symptoms and degree of esophageal mucosal damage are primarily determined by the pH concentration of the refluxate and the duration of esophageal acid exposure. The development of esophagitis requires the presence of acid in the refluxate, with rare exceptions.
• The etiology of GERD can be attributed to such factors as transient lower esophageal sphincter (LES) relaxations, decreased LES resting tone, delayed stomach emptying, ineffective esophageal clearance, and diminished salivation. Other contributing factors include the potency of the refluxed material, and the inability of the esophageal tissue to resist injury and repair itself.
• Factors that may exacerbate the symptoms of GERD in some patients include smoking, caffeine, chocolate, fatty foods, overeating with gastric distention, tight clothing, the presence of a hiatal hernia, and certain medications. A careful history will often show what factors are important for individual patients. While avoidance of exacerbating factors may be helpful, there is relatively little data supporting the efficacy of lifestyle modification alone for the treatment of GERD. Patients should discuss these and other risk factors with their physicians, who can evaluate their condition and advise them on an appropriate treatment plan. It is important that patients follow the treatment plan advised by their physicians.

 

Source: http://www.gerd.com/intro/noframe/patho.htm