- A 65 year-old male presents complaining of heartburn, belching, and epigastic pain. His symptoms are aggravated by drinking coffee and eating fatty foods. His heartburn improves when he takes calcium carbonate.
- Symptomatic reflux of gastric contents into the esophagus
- Transient lower esophageal spincter relaxation is the most common cause
- Other causes include
- ↓ motility secondary to progesterone
- ↑ gastric acidity
- gastric outlet obstruction
- ↓ esophageal motility
- hiatal hernia
- Associated with:
- heartburn 30-90 minutes after a meal
- worse with reclining
- improves with antacids
- may mimic asthma/MI
- Diagnosis based on history
- Upper endoscopy
- should be performed if patient has longstanding symptoms
- look for Barrett's esophagus and adenocarcinoma
- 24-hour intraesophageal pH monitoring
- reveals decreased LES pressure
- 1st line - lifestyle changes
- don't lie down after eating
- avoid spicy foods
- eat small servings
- 2nd line
- H2 receptor antagonists (cimetidine, ranitidine) or
- a promotility agent (cisapride) in patients with LES
- 3rd line
- proton pump inhibitors (omeprazole, lansoprazole)
- PPI's are often used as the best initial therapy and are both diagnostic and therapeutic
- 4th line
- surgical fundiplication or hiatal hernia repair
- wrapping of stomach around GE junction
AVERAGE 4.0 of 6 RATINGS
Qbank (0 Questions)
Cook MB1, Corley DA2, Murray LJ3, Liao LM1, Kamangar F4, Ye W5, Gammon MD6, Risch HA7, Casson AG8, Freedman ND1, Chow WH9, Wu AH10, Bernstein L11, Nyrén O5, Pandeya N12, Whiteman DC12, Vaughan TL13. Gastroesophageal reflux in relation to adenocarcinomas of the esophagus: a pooled analysis from the Barrett's and Esophageal Adenocarcinoma Consortium (BEACON). PLoS One. 2014 Jul 30;9(7):e103508. doi: 10.1371/journal.pone.0103508. eCollection 2014.
PMID:25075959 (Link to Abstract)
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
Heidelbaugh JJ, Nostrant TT, Kim C, Van Harrison R. Management of gastroesophageal reflux disease. Am Fam Physician. 2003 Oct 1;68(7):1311-8. Review.
PMID:14567485 (Link to Abstract)
Heidelbaugh JJ, Gill AS, Van Harrison R, Nostrant TT. Atypical presentations of gastroesophageal reflux disease. Am Fam Physician. 2008 Aug 15;78(4):483-8. Review.
PMID:18756656 (Link to Abstract)
Layke JC1, Lopez PP. Esophageal cancer: a review and update. Am Fam Physician. 2006 Jun 15;73(12):2187-94.
PMID:16836035 (Link to Abstract)
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