Gastroesophageal Reflux Disease
Authors: Jennifer F. Wilson
Journal: Annals of Internal Medicine (2008)

In the Clinic5 August 2008Gastroesophageal Reflux DiseaseChristine Laine, MD, MPH, David R. Goldman, MD, and Jennifer F. Wilson,Christine Laine, MD, MPHSearch for more papers by this author, David R. Goldman, MDSearch for more papers by this author, and Jennifer F. Wilson,Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-3-200808050-01002 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editor's Note: This issue of In the Clinic has been updated.DiagnosisGastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders in Western industrialized countries. Men and women develop GERD with equal frequency, but complicated GERD occurs more frequently in men and with advanced age. It is typically the result of prolonged exposure of the esophagus to gastric acid due to impaired esophageal motility, defects in the lower esophageal sphincter, and impairments in the antireflux barrier at the gastroesophageal junction. The acid exposure can damage the esophageal mucosa, potentially leading to Barrett's esophagus and esophageal cancer. GERD ...References1. DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005; 100:190-200. [PMID: 15654800] Google Scholar2. Klauser AG, Schindlbeck NE, Müller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet. 1990;335:205-8. [PMID: 1967675] Google Scholar3. Fass R, Ofman JJ, Sampliner RE, et al. The omeprazole test is as sensitive as 24-h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive oesophagitis. Aliment Pharmacol Ther. 2000;14:389-96. [PMID: 10759617] Google Scholar4. Schenk BE, Kuipers EJ, Klinkenberg-Knol EC, et al. Omeprazole as a diagnostic tool in gastroesophageal reflux disease. Am J Gastroenterol. 1997;92:1997-2000. [PMID: 9362179] Google Scholar5. Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a test for gastro-esophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med. 2004;140:518-27. [PMID: 15068979] Google Scholar6. Tefera L, Fein M, Ritter MP, et al. Can the combination of symptoms and endoscopy confirm the presence of gastroesophageal reflux disease? Am Surg. 1997;63:933-6. [PMID: 9322676] Google Scholar7. Schindlbeck NE, Wiebecke B, Klauser AG, et al. Diagnostic value of histology in non-erosive gastro-oesophageal reflux disease. Gut. 1996;39:151-4. [PMID: 8977332] Google Scholar8. Hewson EG, Sinclair JW, Dalton CB, Richter JE. Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med. 1991;90:576-83. [PMID: 2029015] Google Scholar9. Davies HA, Jones DB, Rhodes J, Newcombe RG. Angina-like esophageal pain: differentiation from cardiac pain by history. J Clin Gastroenterol. 1985;7:477-81. [PMID: 4086742] Google Scholar10. Martinez SD, Malagon IB, Garewal HS, et al. Non-erosive reflux disease (NERD)—-acid reflux and symptom patterns. Aliment Pharmacol Ther. 2003; 17:537-45. [PMID: 12622762] Google Scholar11. Sharma N, Agrawal A, Freeman J, et al. An analysis of persistent symptoms in acid-suppressed patients undergoing impedendance-ph monitoring. Clin Gastroenterol Hepatol. 2008; 6: 521-4. [PMID: 18356117] Google Scholar12. Johnston BT, Troshinsky MB, Castell JA, et al. Comparison of barium radiology with esophageal pH monitoring in the diagnosis of gastro-esophageal reflux disease. Am J Gastroenterol. 1996;91: 1181-5. [PMID: 8651167] Google Scholar13. O'Connor HJ. Review article: Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management. Aliment Pharmacol Ther. 1999;13:117-27. [PMID: 10102940] Google Scholar14. Goldblum JR, Vicari JJ, Falk GW, et al. Inflammation and intestinal metaplasia of the gastric cardia: the role of gastroesophageal reflux and H. pylori infection. Gastroenterology. 1998;114:633-9. [PMID: 9516382] Google Scholar15. Ishiki K, Mizuno M, Take S, et al. Helicobacter pylori eradication improves pre-existing reflux esophagitis in patients with duodenal ulcer disease. Clin Gastroenterol Hepatol. 2004;2:474-9. [PMID: 15181615] Google Scholar16. Lundell L, Miettinen P, Myrvold HE, et al. Lack of effect of acid suppression therapy on gastric atrophy. Nordic Gerd Study Group. Gastroenterology. 1999;117: 319-26. [PMID: 10419912] Google Scholar17. Gillen D, Wirz AA, Neithercut WD, et al. Helicobacter pylori infection potentiates the inhibition of gastric acid secretion by omeprazole. Gut. 1999;44:468-75. [PMID: 10075952] Google Scholar18. Vaezi MF, Falk GW, Peek RM, et al. CagA-positive strains of Helicobacter pylori may protect against Barrett's esophagus. Am J Gastroenterol. 2000;95:2206-11. [PMID: 11007219] Google Scholar19. Corley DA, Kubo A, Zhao W. Abdominal obesity, ethnicity and gastro-oesophageal reflux symptoms. Gut. 2007;56:756-62. [PMID: 17047097] Google Scholar20. Lagergren J, Bergström R, Nyrén O. No relation between body mass and gastro-oesophageal reflux symptoms in a Swedish population based study. Gut. 2000;47:26-9. [PMID: 10861260] Google Scholar21. Australian Cancer Study. Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus. Gut. 2008;57:173-80. [PMID: 17932103] Google Scholar22. Lagergren J, Bergström R, Adami HO, Nyrén O. Association between medications that relax the lower esophageal sphincter and risk for esophageal adenocarcinoma. Ann Intern Med. 2000; 133:165-75. [PMID: 10906830] Google Scholar23. Behar J, Sheahan DG, Biancani P, et al. Medical and surgical management of reflux esophagitis. A 38-month report of a prospective clinical trial. N Engl J Med. 1975;293:263-8. [PMID: 237234] Google Scholar24. Lieberman DA. Medical therapy for chronic reflux esophagitis. Long-term follow-up. Arch Intern Med. 1987;147:1717-20. [PMID: 3116959] Google Scholar25. Simon TJ, Berlin RG, Gardner AH, et al. Self-Directed Treatment of Intermittent Heartburn: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Evaluation of Antacid and Low Doses of an H(2)-Receptor Antagonist (Famotidine). Am J Ther. 1995;2:304-313. [PMID: 11850668] Google Scholar26. Robinson M, Rodriguez-Stanley S, Miner PB, et al. Effects of antacid formulation on postprandial oesophageal acidity in patients with a history of episodic heartburn. Aliment Pharmacol Ther. 2002;16:435-43. [PMID: 11876696] Google Scholar27. Euler AR, Murdock RH Jr, Wilson TH, et al. Ranitidine is effective therapy for erosive esophagitis. Am J Gastroenterol. 1993;88:520-4. [PMID: 8470632] Google Scholar28. Kahrilas PJ, Fennerty MB, Joelsson B. High- versus standard-dose ranitidine for control of heartburn in poorly responsive acid reflux disease: a prospective, controlled trial. Am J Gastroenterol. 1999;94:92-7. [PMID: 9934737] Google Scholar29. Inadomi JM, Jamal R, Murata GH, et al. Step-down management of gastroesophageal reflux disease. Gastro- enterology. 2001;121:1095-100. [PMID: 11677201] Google Scholar30. Dean BB, Gano AD Jr, Knight K, et al. Effectiveness of proton pump inhibitors in nonerosive reflux disease. Clin Gastroenterol Hepatol. 2004;2:656-64. [PMID: 15290657] Google Scholar31. Lind T, Havelund T, Carlsson R, et al. Heartburn without oesophagitis: efficacy of omeprazole therapy and features determining therapeutic response. Scand J Gastroenterol. 1997;32:974-9. [PMID: 9361168] Google Scholar32. Richter JE, Peura D, Benjamin SB, et al. Efficacy of omeprazole for the treatment of symptomatic acid reflux disease without esophagitis. Arch Intern Med. 2000;160:1810-6. [PMID: 10871975] Google Scholar33. Gardner JD, Ciociola AA, Robinson M, et al. Determination of the time of onset of action of ranitidine and famotidine on intra-gastric acidity. Aliment Pharmacol Ther. 2002;16:1317-26. [PMID: 12144582] Google Scholar34. Castell DO, Kahrilas PJ, Richter JE, et al. Esomeprazole (40 mg) compared with lansoprazole (30 mg) in the treatment of erosive esophagitis. Am J Gastroenterol. 2002;97:575-83. [PMID: 11922549] Google Scholar35. Schindlbeck NE, Klauser AG, Berghammer G, et al. Three year follow up of patients with gastrooesophageal reflux disease. Gut. 1992;33:1016-9. [PMID: 1356887] Google Scholar36. Hetzel DJ, Dent J, Reed WD, et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology. 1988;95:903-12. [PMID: 3044912] Google Scholar37. Carlsson R, Dent J, Watts R, et al. Gastro- oesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole. International GORD Study Group. Eur J Gastroenterol Hepatol. 1998;10:119-24. [PMID: 9581986] Google Scholar38. Vigneri S, Termini R, Leandro G, et al. A comparison of five maintenance therapies for reflux esophagitis. N Engl J Med. 1995;333:1106-10. [PMID: 7565948] Google Scholar39. Yang YX, Hennessy S, Propert K, et al. Chronic proton pump inhibitor therapy and the risk of colorectal cancer. Gastroenterology. 2007;133:748-54. [PMID: 17678926] Google Scholar40. Robertson DJ, Larsson H, Friis S, et al. Proton pump inhibitor use and risk of colorectal cancer: a population-based, case-control study. Gastroenterology. 2007;133:755-60. [PMID: 17678921] Google Scholar41. Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296:2947-53. [PMID: 17190895] Google Scholar42. Laheij RJ, Sturkenboom MC, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004;292: 1955-60. [PMID: 15507580] Google Scholar43. Garc'a Rodr'guez LA, Ruigmez A, Panés J. Use of acid-suppressing drugs and the risk of bacterial gastroenteritis. Clin Gastroenterol Hepatol. 2007;5:1418-23. [PMID: 18054750] Google Scholar44. Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA. 2005;294: 2989-95. [PMID: 16414946] Google Scholar45. Termanini B, Gibril F, Sutliff VE, et al. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison syndrome. Am J Med. 1998;104:422-30. [PMID: 9626024] Google Scholar46. Spechler SJ. Medical or invasive therapy for GERD: an acidulous analysis. Clin Gastroenterol Hepatol. 2003;1:81-8. [PMID: 15017499] Google Scholar47. Dire CA, Jones MP, Rulyak SJ, Kahrilas PJ. The economics of laparoscopic Nissen fundoplication. Clin Gastroenterol Hepatol. 2003;1:328-32. [PMID: 15017676] Google Scholar48. Spechler SJ, Lee E, Ahnen D, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow- up of a randomized controlled trial. JAMA. 2001;285: 2331-8. [PMID: 11343480] Google Scholar49. Hogan WJ. Spectrum of supra-esophageal complications of gastro-esophageal reflux disease. Am J Med. 1997;103:77S-83S. [PMID: 9422629] Google Scholar50. Lieberman DA, Oehlke M, Helfand M. Risk factors for Barrett's esophagus in community-based practice. GORGE consortium. Gastroenterology Outcomes Research Group in Endoscopy. Am J Gastroenterol. 1997;92:1293-7. [PMID: 9260792] Google Scholar51. Streitz JM Jr, Andrews CW Jr, Ellis FH Jr. Endoscopic surveillance of Barrett's esophagus. Does it help? J Thorac Cardiovasc Surg. 1993;105:383-7; discussion 387-8. [PMID: 8445916] Google Scholar52. Peters JH, Clark GW, Ireland AP, et al. Outcome of adenocarcinoma arising in Barrett's esophagus in endoscopically surveyed and nonsurveyed patients. J Thorac Cardiovasc Surg. 1994;108:813-21; discussion 821-2. [PMID: 7967662] Google Scholar53. Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance, and therapy of Barrett's esophagus. Am J Gastroenterol. 2002; 103: 788-797. [PMID: 12190150] Google Scholar54. Conio M, Filiberti R, Blanchi S, et al. Risk factors for Barrett's esophagus: a case-control study. Int J Cancer 2002; 97: 225-229. Google Scholar55. El-Serag HB, Aguirre T, Kuebeler M, Sampliner RE. The length of newly diagnosed Barrett's oesophagus and prior use of acid suppressive therapy. Aliment Pharmacol Ther. 2004;19:1255-60. [PMID: 15191506] Google Scholar56. Csendes A, Braghetto I, Korn O, Cortés C. Late subjective and objective evaluations of antireflux surgery in patients with reflux esophagitis: analysis of 215 patients. Surgery. 1989;105: 374-82. [PMID: 2784232] Google Scholar57. Canadian Association of Gastroenterology GERD Consensus Group. Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults - update 2004. Can J Gastroenterol. 2005;19:15-35. [PMID: 15685294] Google Scholar58. Falk GW, Fennerty MB, Rothstein RI. AGA Institute medical position statement on the use of endoscopic therapy for gastro-esophageal reflux disease. Gastro-enterology. 2006;131: 1313-4. [PMID: 17030198] Google Scholar59. Practice Parameters Committee of the American College of Gastroenterology. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668-85. [PMID: 17335450] Google Scholar60. Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for Surgical Treatment of Gastroesophageal Reflux Disease (GERD). 2001. Accessed at www.sages.org/ publications/publication.php?id=22 on 10 June 2008. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMedical evaluation for patients with symptomatic esophageal diseaseDyspepsiaGuidance on the use of over-the-counter proton pump inhibitors for the treatment of GERDRecent Publications on Medications and Pharmacy 5 August 2008Volume 149, Issue 3Page: ITC2-1KeywordsBarrett's esophagusDysplasiaEndoscopyEsophagusGastroesophageal reflux diseaseIschemiaProton pump inhibitorsStomachSurgeryTreatment guidelines ePublished: 5 August 2008 Issue Published: 5 August 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...