Definition
Gastroesophageal reflux disease (GERD) refers to the backward flow of gastric contents (hydrochloric acid, pepsin ± food) into the esophagus, leading to mucosal injury, inflammation (esophagitis), and symptoms such as heartburn (pyrosis).
Etiology & Pathogenesis
- GERD occurs due to transient or persistent relaxation of the lower esophageal sphincter (LES), allowing gastric contents to reflux into the esophagus.
Main causes and risk factors:
- Prolonged acid exposure damages the squamous mucosa → inflammation, erosion, and possible Barrett's esophagus
Symptoms / Clinical Manifestations
- Heartburn (pyrosis): burning sensation in retrosternal/epigastric region
- Often worse after meals or at night
- Often relieved by upright position
- Belching (burping)
- Retrosternal chest pain (can mimic cardiac pain)
- Dysphagia (sometimes in chronic or complicated cases)
- Sour taste or regurgitation of food/acid into mouth
Diagnosis
History-based diagnosis (main method in uncomplicated cases):
- Classic symptom profile (heartburn, postprandial chest discomfort)
Physical Examination
- Often normal
- May find:
- White coating on tongue
- Halitosis (bad breath)
Laboratory Tests
- In case of hiatal hernia or chronic blood loss → microcytic anemia:
- ↓ Hemoglobin
- ↓ Hematocrit
- ↓ RBC count
- ↓ Serum iron
Instrumental (Confirmatory) Tests
- Esophagogastroduodenoscopy (EGD / gastroscopy): visualize inflammation, erosion, ulcers, Barrett's esophagus
- 24-hour esophageal pH monitoring: most specific test (acid reflux causes pH ≤ 4) Gold std
- Barium swallow X-ray: can detect reflux or hiatal hernia
- Esophageal manometry: assesses motor function of upper and lower esophageal spincter.