Teachers' Topics Gastroesophageal Reflux Disease

PROLOGUE Gastroesophageal reflux disease (GERD) is a pathologic condition of injury to the esophagus caused by regurgitation of gastric or gastroduodenal contents into the lumen of the esophagus(1). Histopathology of the esophageal mucosa may or may not be present. Gastroesophageal reflux of acid and gastric contents often causes a condition commonly referred to as heartburn. This is characterized as a retro-sternal burning sensation that radiates to the throat and interscapular region. It may be confused, even in the emergency room, with anginal pain or the onset of myocardial infarction; therefore its rapid diagnosis is important. In many patients GERD should be considered a chronic and lifelong illness and maintenance therapy is often needed(2). Repeated exposure of the esophagus to stomach contents leads to esophagitis. In severe cases, this can actually erode esophageal tissue (erosive esophagitis). In the last five to seven years several new treatment options for GERD have become available. These include antise-cretory agents such as the proton pump inhibitors, and new surgical techniques that have improved Nissen fundoplication safety and efficacy rates(3-4). Clinicians caring for patients with this common disorder need to understand the pathology behind GERD, its common (and uncommon) clinical manifestations, and current treatment options as recommended by the American College of Gastroenterology(2).