GERD (Gastroesophageal reflux disease)

GERD (gastroesophageal reflux disease) is extremely common. It occurs when lower esophageal sphincter tone is reduced. The loss of LES tone allows acid reflux, which damages the lower esophagus. Common symptoms include esophagitis with heartburn (epigastric pain that radiates to the chest, beware that it can mimic angina) and acid regurgitation, which can create a characteristic bad taste in the mouth. Some patients also have chronic cough and hoarseness from the acid reflux. May have "sour" breath. Many patients are asymptomatic. Barrett's esophagus & cancer. Beware difficulty/pain with swallowing, early satiety, weight loss. Endoscopy may show erosion, ulcers, and stricture formation. Risk factors include alcohol use and tobacco smoking.

• Lifestyle Changes
• Antacids
• Proton-pump inhibitors
• H2RAs (histamine type 2 receptor blockers)

In some cases, Nissen fundoplication is performed to surgically create a new lower esophageal sphincter. Lifestyle changes include:

• Avoidance of large, high-fat meals.
• Avoidance of foods or medications known to irritate the esophagus or relax the LES
• Ex: peppermint, chocolate, alcohol, carbonated drinks, tomato/citrus, NSAIDs, Calcium channel blockers, nitrates, opiods, Anticholinergics, etc.
• Smoking cessation