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If there are no symptoms or signs of complications and no suspicion of other diseases, a therapeutic trial of acid suppression with H2 antagonists often is used. If H2 antagonists are not adequately effective, a second trial, with the more potent PPIs, can be given.

Although chronic cough and asthma are common ailments, it is not clear just how often they are aggravated or caused by GERD. Ulcers of the esophagus heal with the formation of scars (fibrosis). Over time, the scar tissue shrinks and narrows the lumen (inner cavity) of the esophagus. This scarred narrowing is called a stricture.

Sometimes, a trial of treatment begins with a PPI and skips the H2 antagonist. If treatment relieves the symptoms completely, no further evaluation may be necessary and the effective drug, the H2 antagonist or PPI, is continued. As discussed previously, however, there are potential problems with this commonly used approach, and some physicians would recommend a further evaluation for almost all patients they see.

Other symptoms

This condition is referred to as Barrett’s esophagus and occurs in approximately 10% of patients with GERD. The type of esophageal cancer associated with Barrett’s esophagus (adenocarcinoma) is increasing in frequency. It is not clear why some patients with GERD develop Barrett’s esophagus, but most do not. As previously mentioned, swallows are important in eliminating acid in the esophagus. Swallowing causes a ring-like wave of contraction of the esophageal muscles, which narrows the lumen (inner cavity) of the esophagus.

Loose-fitting clothes won’t add this pressure. The most recently approved procedure involves surgically placing a ring known as a LINX device around the outside of the lower end of the esophagus, the tube that connects the mouth to the stomach.

In healthy patients, the “angle of His”-the angle at which the esophagus enters the stomach-creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue. Gastroesophageal reflux is a normal physiologic event that may occur as often as once an hour.1 The causes for the transformation of this normal process into a chronic, relapsing illness have not been well defined, but numerous factors are thought to be involved. The symptoms of gastroesophageal reflux disease (GERD) vary from patient to patient, and multiple diagnostic tests and treatments are available. Given the variability of symptoms and the prevalence of GERD, family physicians need to understand the presentations, diagnosis and treatments of this illness. Could you have GERD (Gastroesophageal Reflux Disease)?

Diagnosis of GERD

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Gastroesophageal reflux disease (GERD) may cause irritation or inflammation in the esophagus, the tube that connects the throat to the stomach. This condition is called esophagitis. GERD without esophagitis is sometimes called non-erosive reflux disease. Parameters on esophageal pH-impedance monitoring that predict outcomes of patients with gastroesophageal reflux disease . Hypersensitivity to acid is associated with impaired esophageal mucosal integrity in patients with gastroesophageal reflux disease with and without esophagitis .

They remain the mainstay of pharmacologic treatment. In addition to lifestyle modifications, patients with mild symptoms often require periodic drug therapy for symptom relief.

STAGE IV: MAINTENANCE THERAPY

Frequent or constant reflux can lead to gastroesophageal reflux disease (GERD). Stomach abnormalities. One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia, which can occur in people of any age. A hiatal hernia happens when the upper part of the stomach and LES (lower esophageal sphincter) move above the diaphragm.

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages-from infants to older adults.

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