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Gastroesophageal Reflux Disease (GERD)

Epidemiology

In the United States, the prevalence range for GERD is 10% to 20% of the population. The prevalence rate of GERD in developed nations is also tightly linked with age, with adults aged 50 to 70 being the most commonly affected. The combination of longer life expectancy and aging populations in the developed world is expected to lead to an increase in GERD prevalence in the years to come.

Signs and symptoms

The most-common symptoms of GERD are:

Other symptoms include:

GERD can cause injury to the esophagus. These injuries may include:

Reflux esophagitis – erosion of the esophageal tissue causing ulcers near the junction of the stomach and esophagus.
Endoscopic Pictures of a Reflux Esophagitis (Red Streaks are erosions in the esophagus)

  • Esophageal strictures – the persistent narrowing of the esophagus caused by reflux-induced inflammation and scarring.

Endoscopic Picture of Esophageal Stricture (Scarring in the esophagus)
Endoscopic Picture of Esophageal Stricture (Scarring in the esophagus)

Barrett's Esophagus (Pre-Cancerous lesion due to GERD)
Barrett's Esophagus (Pre-Cancerous lesion due to GERD

 

Adenocarcinoma of the Esophagus (Also Shown is Barrett's)
Adenocarcinoma of the Esophagus (Also Shown is Barrett's)

 

Pathophysiology

GERD is caused by a failure of the Lower Esophageal Sphincter. In healthy patients, the Lower Esophageal Sphincter creates a valve that prevents bile, pancreatic enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue.

Factors that can contribute to GERD:

  • Genetics: GERD appears to be predominately an inherited disorder and seems to run in families. This is probably the single most important cause of GERD.
  • Hiatal hernia, which increases GERD due to mechanical and motility factors. Aproximately 80% of patients with GERD will have a hiatal hernia.
  • Obesity: increasing body mass index is associated with more severe GERD. In a large series of 2000 patients with symptomatic reflux disease, it has been shown that 13 % of changes in esophageal acid exposure is attributable to changes in body mass index.
  • Zollinger-Ellison syndrome: a rare disorder in which patients have increased gastric acid production due to excessive gastrin production.
  • Hypercalcemia, which can increase gastrin production, leading to increased acidity.
  • Scleroderma and systemic sclerosis
  • The use of many medications such as prednisone (steroids), blood pressure and osteoporosis medications.

 

Next > Diagnosis and Diagnostic Testing of the Esophagus/Stomach

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Upper G.I. and General Surgery

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