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
