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 within 3hr of sleep
4. PPI or H2 blocker

Disposition

• Home (outpatient treatment)

See Also

• Abdominal Pain