Ver el código de «Gastroesophageal reflux disease»

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==Background==

[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]]
*Abbreviation: GERD
*Definition: a highly variable chronic condition that is characterized by periodic episodes of backward flow of the gastric contents into the esophagus due to improper functioning of a sphincter at the lower end of the esophagus
**Usually accompanied by "heartburn" symptoms and histopathologic changes in the esophagus
*Affects up to 20% of population
*Assume [[Special:MyLanguage/chest pain|chest pain]] is cardiac origin until proven otherwise


===Causes===

*Decreased pressure of lower esophageal sphincter
**High-fat food
**Nicotine
**[[Special:MyLanguage/Ethanol|Ethanol]]
**[[Special:MyLanguage/Caffeine|Caffeine]]
**Medications (mintrates, [[Special:MyLanguage/calcium-channel blockers|calcium-channel blockers]], [[Special:MyLanguage/anticholinergics|anticholinergics]], progesterone/estrogen)
**[[Special:MyLanguage/Pregnancy|Pregnancy]]
*Decreased esophageal motility
**[[Special:MyLanguage/Achalasia|Achalasia]]
**[[Special:MyLanguage/Scleroderma|Scleroderma]]
**[[Special:MyLanguage/Diabetes|Diabetes]]
*Prolonged gastric emptying
**[[Special:MyLanguage/Anticholinergics|Anticholinergics]]
**Outlet obstruction
**Diabetic [[Special:MyLanguage/gastroparesis|gastroparesis]]
*High-fat food


==Clinical Features==

[[File:GERD 2.png|thumb|Severe tooth erosion in GERD<ref>Ranjitkar S, Kaidonis JA, Smales RJ (2012). "Gastroesophageal Reflux Disease and Tooth Erosion". International Journal of Dentistry. 2012: 479850. doi:10.1155/2012/479850. ISSN 1687-8728. PMC 3238367. PMID 22194748.</ref>]]

===Typical===

*[[Special:MyLanguage/epigastric pain|Pain]] and discomfort with or right after meals
**typically described as burning pain
**often worse when lying flat
*+/-[[Special:MyLanguage/Dysphagia|Dysphagia]]


===Atypical===

*[[Special:MyLanguage/Chest pain|Chest pain]] with features similar to [[Special:MyLanguage/ACS|ACS]]:
**Exertional, associated with diaphoresis, nausea/[[Special:MyLanguage/vomiting|vomiting]], radiating to arm
*[[Special:MyLanguage/Asthma|Asthma]]
*[[Special:MyLanguage/Pneumonia|Pneumonia]]
*Hoarseness
*Aspiration


===Pediatric===

*Reflux is physiologic in infants
*Pathologic only if it causes complications, such as:
**[[Special:MyLanguage/Failure to thrive (peds)|Failure to thrive]]/weight loss
**[[Special:MyLanguage/Esophagitis|Esophagitis]]
**Respiratory disease: refractory [[Special:MyLanguage/asthma|asthma]], recurrent [[Special:MyLanguage/pneumonia|pneumonia]], apnea
**[[Special:MyLanguage/BRUE|BRUE]]


==Differential Diagnosis==

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{{Abdominal Pain DDX Epigastric}}
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==Management==

[[File:Peptic stricture.png|thumb|Endoscopic image showing narrowing of the esophagus near the junction with the stomach, a complication of chronic gastroesophageal reflux disease that can cause dysphagia.]]
*Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
*Sleep with head of bed elevated
*Avoid eating within 3hr of sleep
*[[Special:MyLanguage/PPI|PPI]], [[Special:MyLanguage/H2 blocker|H2 blocker]], [[Special:MyLanguage/bismuth subsalicylate|bismuth subsalicylate]]


===Infants===

*Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds
**medications only if significant complications


==Disposition==

*Home (outpatient treatment)


==See Also==

*[[Special:MyLanguage/Abdominal Pain|Abdominal Pain]]


==References==

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[[Category:GI]]
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