Gastroesophageal reflux disease

Background

• Affects up to 20% of population
• Assume chest pain is cardiac origin until proven otherwise

Causes

• Decreased pressure of lower esophageal sphincter
  • High-fat food
  • Nicotine
  • Ethanol
  • Caffeine
  • Meds (mintrates, CCBs, anticholinergics, progesterone/estrogen)
  • Pregnancy
• Decreased esophageal motility
  • Achalasia
  • Scleroderma
  • Diabetes
• Prolonged gastric emptying
  • Anticholinergics
  • Outlet obstruction
  • Diabetic gastroparesis
• High-fat food

Diagnosis

• Pain and discomfort with meals
• Chest pain with features similar to ACS:
  • Exertional, associated with diaphoresis, nausea/vomiting, radiating to arm

Differential Diagnosis

Epigastric Pain

• Gastroesophageal reflux disease (GERD)
• Peptic ulcer disease with or without perforation
  • Zollinger-Ellison syndrome
• Gastritis
• Pancreatitis
• Gallbladder disease
  • Acute cholecystitis
  • Cholangitis
  • Symptomatic cholelithiasis
  • Acalculous cholecystitis
• Myocardial Ischemia
• Splenic Infarctionenlargement/rupture/aneurysm
• Pericarditis/Myocarditis
• Aortic dissection
• Hepatitis
• Pyelonephritis
• Pneumonia
• Pyogenic liver abscess
• Fitz-Hugh-Curtis Syndrome
• Hepatomegaly due to CHF
• Bowel obstruction
• SMA syndrome
• Pulmonary embolism
• Bezoar
• Ingested foreign body

Management

1. Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
2. Sleep with head of bed elevated
3. Avoid eating w/in 3hr of sleep
4. PPI or H2 blocker

Disposition

• Home (outpatient treatment)

See Also

• Abdominal Pain