Gastroesophageal Reflux Disease

Abstract

This issue provides a clinical overview of gastroesophageal reflux disease, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic.

Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux

“…Laparoscopic antireflux surgery with fundoplication is a treatment alternative in patients with inadequate response to pharmacological treatment. 4,5 In contrast to medication, which reduces the acidity of the refluxate, antireflux surgery creates a mechanical barrier, preventing the refluxate from passing into the esophagus. Randomized clinical trials conducted in referral centers have shown a relatively low rate of reflux recurrence (up to 15%) after antireflux surgery.…”

Effectiveness and Tolerability of Different Recommended Doses of PPIs and H2RAs in GERD: Network Meta-Analysis and GRADE system

“…The corresponding GERD symptoms include heartburn, regurgitation, odynophagia, nausea, chest pain and coughing3. Without effective treatment, complications worsen and further develop into reflux esophagitis, esophageal strictures, and Barrett’s esophagus345, and in severe cases, esophageal adenocarcinoma may also occur67.…”

Cohort profile: the Nordic Antireflux Surgery Cohort (NordASCo)

“…The primary symptoms of GORD are heartburn and regurgitation of stomach contents. 2 Other, less common symptoms include chest pain, nausea, hoarseness and symptoms associated with bronchial aspiration of reflux contents reaching the oropharynx, for example, pneumonia, cough and other respiratory disorders. 2 The prevalence of GORD is estimated at 10%–20% in the USA and Europe, and less than 5% in Asia.…”

“… 2 Other, less common symptoms include chest pain, nausea, hoarseness and symptoms associated with bronchial aspiration of reflux contents reaching the oropharynx, for example, pneumonia, cough and other respiratory disorders. 2 The prevalence of GORD is estimated at 10%–20% in the USA and Europe, and less than 5% in Asia. 3 The prevalence has increased during the last few decades, 4 an increase that correlates with the increasing prevalence of obesity, a known risk factor for developing GORD.…”

“… 8–11 GORD can lead to complications, including erosive oesophagitis, oesophageal strictures, premalignant Barrett’s oesophagus and oesophageal adenocarcinoma. 2 The primary treatment is medical, most often using a proton pump inhibitor. An alternative but less often used treatment is antireflux surgery, during which the fundus of the stomach is wrapped partly or completely around the lower oesophagus, mechanically hindering GORD.…”