Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is a common condition in which stomach contents back up into the esophagus, causing uncomfortable symptoms.

The esophagus is the muscular tube connecting the mouth to the stomach. In the stomach, acid is produced to help digest food. If acidic stomach content reaches the esophagus, it can cause long-standing and troublesome symptoms or specific complications, known as gastroesophageal reflux disease (GERD). GERD is one of the most common diseases, and it is estimated that approximately 20% of the adult population in the Western world experiences GERD.

Patients with GERD have an ineffective valve mechanism between the esophagus and stomach (lower esophageal sphincter), which otherwise prevents stomach contents from backing up into the esophagus. GERD occurs more frequently if a part of the stomach is pushed up into the thoracic cavity, a condition called a hiatal hernia. Risk factors for developing GERD are obesity, tobacco smoking, and heredity.

The most common symptoms of GERD are burning sensations behind the breastbone (heartburn) or the sensation of regurgitation of stomach contents into the upper throat (acid regurgitation). In individuals with typical symptoms, treatment is often prescribed without further examination. Long-standing GERD can lead to inflammation of the esophagus and can also lead to cell changes in the esophagus that slightly increase the risk of developing esophageal cancer.

Doctors may advise patients with symptoms of GERD to make lifestyle changes, such as lose weight and stop smoking. The first-line medical treatment for GERD is a proton pump inhibitor (PPI), such as omeprazole or esomeprazole. Proton pump inhibitors inhibit production of acid in the cells of the stomach wall, thereby reducing the acidic contents and the symptoms of GERD. Most patients who have symptoms of GERD are prescribed a PPI trial, in which they take a PPI daily for a couple of weeks, and if their symptoms clearly diminish, it provides evidence for a diagnosis of GERD. In some patients, especially young and otherwise healthy people, a surgical procedure known as fundoplication can be considered. During a fundoplication, the upper part of the stomach is wrapped around the lower esophagus, thereby mechanically and physiologically preventing GERD.

Conflict of Interest Disclosures: None reported.

Source: Maret-Ouda J, Markar SR, Lagergren J. Gastroesophageal reflux disease: a review. JAMA. Published December 22, 2020. doi:10.1001/jama.2020.21360