Gastroesophageal reflux

From IDWiki

Definition

  • Chronic non-forceful reflux of stomach contents past lower esophageal sphincter, producing a variety of symptoms

Classification

  • May be erosive or non-erosive (NERD)

Pathophysiology

  • Decreased tone of lower esophageal sphincter that normally prevents regurgitation

Differential Diagnosis

  • Heartburn symptoms
    • Myocardial ischemia
  • Chronic cough
    • Asthma
    • Upper airway syndrome (post-nasal drip)

Management

  • Stepwise management
  • Step 1: lifestyle management
    • No food for 4h before sleeping
    • Eat upright, stay upright for 1h after meal
    • Avoidance of trigger foods, such as coffee, alcohol, spicy food
    • Sleep with elevated head of bed
  • Step 2: proton pump inhibitor (PPI) therapy
    • Pantoprazole 40mg po daily 30 minutes before breakfast
  • Step 3: twice-daily PPI
    • As above, but bid 30 minutes before breakfast and dinner
  • Step 4: things for which there is no evidence
    • Consider further investigations such as 24h pH monitoring