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...

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.

Symptoms

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.

Adults

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)

Complications:

• 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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