Gastroesophageal Reflux

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 31/05/2015

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Chapter 25 Gastroesophageal Reflux

INTRODUCTION

Description: The reflux of gastric acid to the sensitive esophagus causes heartburn, the cardinal manifestation of gastroesophageal reflux disease (GERD).
Prevalence: Common.
Predominant Age: Generally reproductive and beyond.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: The most common cause is decreased tone of the lower esophageal sphincter (LES). This is complicated in pregnant patients by the reduced gastric emptying and reduced esophageal sphincter tone that occur during pregnancy.
Risk Factors: Cigarette smoking, alcohol abuse, some medications or foods, pregnancy, scleroderma, sliding hiatal hernia.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Upper abdominal pain, nausea, vomiting, dyspepsia, heartburn, chest pain, and “gas” (70% to 85%; symptoms most common after large meals, consuming certain foods, and on assuming the recumbent position)
• Dysphagia (15% to 20%, suggests stricture)
• Bronchospasm/asthma (15% to 20%)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Ulcer disease (gastric or duodenal)
• Chemical or infectious esophagitis
• Crohn’s disease of the esophagus
• Angina pectoris
• Achalasia
• Esophageal cancer

Associated Conditions: Dysphagia. Nocturnal aspiration may occur and be mistaken for asthma.

Workup and Evaluation

Laboratory: No evaluation indicated.
Imaging: Barium swallow may demonstrate hiatal hernia or esophageal narrowing. For patients who are pregnant, this should be reserved for after completion of the pregnancy.
Special Tests: Upper gastrointestinal endoscopy eliminates other potential causes of gastroesophageal reflux disease that include esophageal motility disorders, erosive esophagitis, and peptic ulcer disease (gastric or duodenal).
Diagnostic Procedures:

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