Esophagus: Gastroesophageal Reflux Disease (GERD) Gastroesophageal Reflux Disease (GERD) Basics General Reflux of Gastric Acid into the Esophagus The Most Common GI Diagnosis in the West 10-20% Prevalence Risk Factors Smoking Alcohol Caffeine Trigger Foods (Fatty/Fried) Gastroparesis Obesity Hiatal Hernia Pregnancy Symptoms Typical Symptoms: Pyrosis (Heartburn) 30-60 Min After Meals Worse When Supine Regurgitation (Perception of Refluxed Gastric Acid into the Mouth) Epigastric Pain Atypical Symptoms: Water Brash (Increased Saliva Production Mixed with Gastric Acid in the Mouth) Odynophagia (Painful Swallowing) Globus Sensation (Perception of a Lump in the Throat) Cough Aspiration Wheezing Hoarse Voice Alarm Symptoms Alarm Symptoms: Dysphagia Weight Loss, Early Satiety or Anorexia GI Bleed (Hematemesis/Melena) or Anemia Persistent Vomiting Need EGD to Evaluate for Cancer GERD 1 Complications Erosive Esophagitis *See Esophagus: Esophagitis Barrett’s Esophagus *See Esophagus: Barrett’s Esophagus Esophageal Stricture *See Esophagus: Dysphagia & Stricture Extraesophageal Complications Asthma Mechanisms: Increased Vagal Tone, Bronchial Reactivity & Microaspiration Laryngotracheal Stenosis Chronic Laryngitis Chronic Cough Dental Erosions Management Immediate Relief *See On Call: Heartburn & Indigestion Initial Therapy Initial Tx: PPI 3-4 Weeks & Lifestyle Modifications Lifestyle Modifications: Weight Loss & Avoid Triggering Foods Medication: Initial Dose: PPI Once Daily If Fails & Diagnosis Confirmed: Increase to Twice Daily or Add H2 Blocker *See Pharmacology & Anesthesia: Anti-Reflux Medication 99% Effective If Fails: Diagnostic Testing Failure Defined as No Improvement After 8-12 Weeks Diagnostic Testing pH Probe First Test to Diagnose (But Not Mandatory) DeMeester Score Components: Percent Total Time pH 5 min Longest Reflux Episode Score > 14.72 Indicat