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Gastroesophageal reflux disease

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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Gastroesophageal reflux disease - Information: from your family doctor
From American Family Physician, 10/1/03

What is gastroesophageal reflux disease?

Gastroesophageal reflux disease, or GERD, is a common digestive problem (say: gas-tro-ess-off-ah-gee-al ree-flux). In GERD, acid from the stomach flows backward into the esophagus.

The lining of the stomach is designed to handle the strong acids that break down food. However, the lining of the esophagus gets irritated when strong acid touches it.

A muscle usually keeps stomach acid from flowing back into the esophagus. If you have GERD, this muscle does not close the right way, and acid from your stomach gets into your esophagus and irritates its lining (see the pictures below).


What are the symptoms of GERD?

The most common symptoms of GERD are heartburn and regurgitation (say: ree-gerj-ih-tay-shun). Heartburn is a burning feeling in your chest. This burning feeling may move up toward your throat. If you have regurgitation, stomach contents mixed with acid back up into your esophagus and cause a bad (sour) taste in your mouth.

Less common symptoms of GERD include too much saliva in your mouth and the feeling that you always have a lump in the back of your throat. Some people with GERD have an ongoing cough, a sore throat, or a hoarse voice.

How is GERD diagnosed?

Most likely, your doctor will be able to tell that you have GERD based on your answers to some questions and the results of your physical exam. You may need to have some tests if medicine does not make you feel better or if you have other symptoms (such as chest pain or choking).

How is GERD treated?

Lifestyle changes may help some symptoms of GERD. Here are some things you can do:

* Avoid foods that may make your symptoms worse, such as acidic foods (citrus- and tomato-based products), alcohol, chocolate, caffeinated drinks, fatty foods, garlic, onions, and peppermint.

* Avoid large meals and do not eat anything for 3 to 4 hours before you go to bed.

* Lose weight, if you need to.

* Raise the head of your bed by 4 to 8 inches.

* If you smoke, stop.

Over-the-counter antacids are sometimes helpful in treating GERD. In addition, your doctor may prescribe a medicine that will help lower the amount of acid in your stomach. Surgery helps some people who do not get better with medicine and lifestyle changes.

How long does GERD last?

The right treatment usually relieves the symptoms of GERD within a few days. However, many people have GERD for a long time. It is common for people to get GERD again.

When should I call my doctor?

You should call your doctor if you have heartburn or regurgitation plus any of the following "alarm" symptoms:

* Blood in your stools

* Chest pain

* Choking

* Early fullness after a meal

* Pain or difficulty when swallowing

* Unexplained weight loss

* Vomiting

COPYRIGHT 2003 American Academy of Family Physicians
COPYRIGHT 2003 Gale Group

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