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Gastroesophageal reflux

Gastroesophageal Reflux Disease (GERD; or GORD when spelling oesophageal, the BE form) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus. . more...

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This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter (LES), transient LES relaxation, or association with a hiatal hernia. Gastric regurgitation is an extension of this process with retrograde flow into the pharynx or mouth.


Heartburn is the symptom of acid in the esophagus, characterized by a burning discomfort behind the breastbone (sternum). Findings in GERD include esophagitis (reflux esophagitis) – inflammatory changes in the esophageal lining (mucosa) – strictures, difficulty swallowing (dysphagia), and chronic chest pain. Patients may have only one of those findings. Atypical symptoms of GERD include cough, hoarseness, changes of the voice, chronic ear ache, or sinusitis. Complicatons of GERD include stricture formation, Barrett's esophagus, esophageal ulcers and possibly even lead to esophageal cancer.

Occasional heartburn is common but does not necessarily mean one has GERD. Patients that have heartburn symptoms more than once a week are at risk of developing GERD. A hiatal hernia is usually asymptomatic, but the presence of a hiatal hernia is a risk factor for development of GERD.


The most prominent symptom of GERD is heartburn, the sensation of burning pain in the chest coming upward towards the mouth caused by reflux of acidic contents from the stomach to the esophagus.

Patients with GERD also tend to get the feeling of a sour or salty taste at the back of their throats due to regurgitation. This can sometimes happen even if the pain of heartburn is absent.

Less common symptoms:

  • Chest pain without any of the above
  • Dysphagia (difficulty swallowing)
  • Halitosis (bad breath)
  • Regurgitation (vomit-like taste in the mouth)
  • Repeated throat clearing
  • Water brash (the sensation of a large amount of non-acid liquid due to sudden hypersecretion of saliva)


  • Strictures or scarring of esophagus (especially young children).
  • Barrett's esophagus (sometimes referred to as Barrett's Disease)
  • Esophageal cancer

Important Warning symptoms:

  • Trouble swallowing Dysphagia requires immediate medical attention
  • Vomiting blood or partially-digested blood (looks like coffee grounds) requires immediate medical attention as does digested blood in the stools.

GERD in Children

GERD is commonly overlooked in infants and children. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems. Inconsolable crying, failure to gain adequate weight, refusing food and bad breath are also common. Children may have one symptom or many - no single symptom is universally present in all children with GERD.


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Silent gastroesophageal reflux linked to asthma
From OB/GYN News, 5/15/05 by Kate Johnson

SAN ANTONIO -- Gastroesophageal reflux is a potential trigger for asthma, and should be investigated in patients with persistent asthma even if they report no symptoms of reflux, Susan Harding, M.D., said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

"Silent reflux is common in asthmatics," said Dr. Harding, associate professor of medicine at the University of Alabama at Birmingham.

In one study conducted by her group, 62% of consecutive adults and 23% of children with asthma but with no symptoms of gastroesophageal reflux disease (GERD), had abnormal esophageal acid results when tested (Am. J. Respir. Crit. Care Med. 2000;162:34-9).

"A lot of times people think that having reflux is normal, and so the first time you ask them they say they don't have a problem. But if you call them a week later after they've had a chance to think about it, often you will find that they have noticed problems with certain foods or with eating late at night," she told this newspaper.

Dr. Harding advised physicians to ask patients with persistent asthma about symptoms of GERD, such as reflux and heartburn. Regardless of the presence of symptoms, she suggested an empirical trial of a proton pump inhibitor (PPI), which will clarify whether reflux is causing, or contributing to, the patient's asthma.

"I recommend a high-dose PPI, twice a day for at least 3 months, because it takes time to get acid out of the picture and for the airway inflammation to cool down," she said.

Studies have shown that PPI therapy can improve symptoms and reduce medication use in reflux-triggered asthma, but the effect on pulmonary function has been less striking, she said.

The best study is a soon-to-be published multicenter, placebo-controlled trial of 207 patients with moderate to severe persistent asthma. The results show some promising effects of high-dose PPI therapy (lansoprazole 30 mg twice daily) on asthma symptoms, exacerbations, quality of life, and pulmonary function, Dr. Harding said.

Dr. Harding advised that asthma symptoms should be monitored before and during GERD therapy, and if they do not improve, 24-hour esophageal pH testing (while on GERD therapy) should be considered to confirm that acid is adequately suppressed. If acid is not suppressed, the PPI dose should be increased. But if acid is suppressed, acid reflux is likely not the trigger for the patient's asthma, and GERD should be treated from a symptomatic standpoint only, she said.

Dr. Harding advised cutting the PPI dose to once a day with improvement of asthma symptoms seen with GERD therapy.

"I would also consider adding a prokinetic agent, because reflux is more of an esophageal motility problem, not an acid problem. But metoclopramide, the only prokinetic agent available in the U.S., has a high incidence of central nervous system effects," she said.

And finally, laparoscopic fundoplication has a role in selected patients. "I usually only refer to the surgeon when I know their asthma is truly related to gastroesophageal reflux and they have asthma improvement on reflux therapy," she said.

The link between asthma and GERD is poorly understood, and there is no clear indication as to which condition precedes the other. Some experts believe aggressive treatment of asthma could relieve some symptoms of GERD--but, paradoxically, certain asthma medications have been known to cause acid reflux, Dr. Harding said.

"The asthma medications that seem to worsen reflux include theophylline at high levels, oral corticosteroids, and then repeated amounts of nebulized albuterol, which may alter esophageal function."

Dr. Harding advised treating reflux aggressively in asthma patients, and approaching asthma therapy aggressively as well, with attempts to avoid potential GERD exacerbators.


Montreal Bureau

COPYRIGHT 2005 International Medical News Group
COPYRIGHT 2005 Gale Group

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