View source for Medicine:Gastroesophageal reflux disease

{{Infobox medical condition (new)
| name = Gastroesophageal reflux disease
| synonyms = British: Gastro-oesophageal reflux disease (GORD);<ref name=Carroll2016>{{cite book|last=Carroll|first=Will|title=Gastroenterology & Nutrition: Prepare for the MRCPCH. Key Articles from the Paediatrics & Child Health journal|date=14 October 2016|publisher=Elsevier Health Sciences|isbn=978-0-7020-7092-1|page=130|quote=Gastro-oesophageal reflux disease (GORD) is defined as 'gastrooesophageal reflux' associated with complications including oesophagitis...}}</ref> gastric reflux disease, acid reflux disease, reflux, gastroesophageal reflux
| image = Gastroesophageal reflux barium X-ray.jpg
| caption = [[Physics:X-ray|X-ray]] showing radiocontrast from the stomach (white material below diaphragm) entering the esophagus (three vertical collections of white material in the mid-line of the chest) due to severe reflux
| field = [[Medicine:Gastroenterology|Gastroenterology]]
| pronounce = {{IPAc-en|g|æ|s|t|r|oʊ|ɪ|ˌ|s|ɒ|f|ə|ˈ|dʒ|iː|əl|_|ˈ|r|iː|f|l|ʌ|k|s}}<ref>{{cite web|url=http://www.collinsdictionary.com/dictionary/american/gastro-|title=Definition of "gastro-" - Collins American English Dictionary|url-status=live|archive-url=https://web.archive.org/web/20151208124052/http://www.collinsdictionary.com/dictionary/american/gastro-|archive-date=8 December 2015}}</ref><ref>{{cite web|url=http://www.collinsdictionary.com/dictionary/american/esophagus|title=Definition of "esophagus" - Collins American English Dictionary|url-status=live|archive-url=https://web.archive.org/web/20151208155301/http://www.collinsdictionary.com/dictionary/american/esophagus|archive-date=8 December 2015}}</ref><ref>{{cite web|url=http://www.oxfordlearnersdictionaries.com/definition/american_english/reflux|title=reflux noun - Definition, pictures, pronunciation and usage notes - Oxford Advanced American Dictionary at OxfordLearnersDictionaries.com|url-status=live|archive-url=https://web.archive.org/web/20151208122727/http://www.oxfordlearnersdictionaries.com/definition/american_english/reflux|archive-date=8 December 2015}}</ref> GORD {{IPAc-en|g|ɔː|d}}<ref>{{cite web |url=https://www.lexico.com/definition/GORD |title=GORD &#124; Meaning & Definition for UK English |publisher=Lexico.com |date= |access-date=11 February 2022 |archive-date=11 February 2022 |archive-url=https://web.archive.org/web/20220211024610/https://www.lexico.com/definition/GORD }}</ref> GERD {{IPAc-en|g|ɝ|d}}
| symptoms = Taste of acid, heartburn, bad breath, [[Medicine:Chest pain|chest pain]], breathing problems<ref name=NIH2014/>
| complications = [[Medicine:Esophagitis|Esophagitis]], esophageal strictures, Barrett's esophagus<ref name=NIH2014/>
| onset =
| duration = Long term<ref name=NIH2014/><ref name=Kah2008/>
| causes = Inadequate closure of the lower esophageal sphincter<ref name=NIH2014/>
| risks = Obesity, [[Medicine:Pregnancy|pregnancy]], [[Medicine:Smoking|smoking]], [[Medicine:Hiatal hernia|hiatal hernia]], taking certain medicines<ref name=NIH2014/>
| diagnosis = Gastroscopy, upper GI series, [[Medicine:Esophageal pH monitoring|esophageal pH monitoring]], esophageal manometry<ref name=NIH2014/>
| differential = [[Medicine:Peptic ulcer disease|Peptic ulcer disease]], [[Medicine:Esophageal cancer|esophageal cancer]], [[Medicine:Esophageal spasm|esophageal spasm]], [[Medicine:Angina|angina]]<ref>{{cite book|last1=Kahan|first1=Scott|title=In a Page: Medicine|date=2008|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-7035-4|page=124|url=https://books.google.com/books?id=46wpAUhUHjMC&pg=PA124|url-status=live|archive-url=https://web.archive.org/web/20170908180953/https://books.google.com/books?id=46wpAUhUHjMC&pg=PA124|archive-date=8 September 2017}}</ref>
| prevention =
| treatment = Lifestyle changes, medications, surgery<ref name=NIH2014/>
| medication = [[Chemistry:Antacid|Antacid]]s, [[Chemistry:H2 antagonist|H<sub>2</sub> receptor blockers]], proton pump inhibitors, prokinetics<ref name=NIH2014/><ref name=Her2011/>
| prognosis =
| frequency = ~15% (North American and European populations)<ref name=Her2011/>
| deaths =
}}
<!-- Definition and symptomes -->
'''Gastroesophageal reflux disease''' ('''GERD''') or '''gastro-oesophageal reflux disease''' ('''GORD''')  is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or complications.<ref name=NIH2014/><ref name=Kah2008>{{cite journal |vauthors=Kahrilas PJ, Shaheen NJ, Vaezi MF |title=American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease |journal=Gastroenterology |date=October 2008 |volume=135 |issue=4 |pages=1392–1413, 1413.e1–5 |pmid=18801365 |doi=10.1053/j.gastro.2008.08.044 |doi-access=free }}</ref><ref name=":2">{{Cite journal |last=Parker |first=Melinda |date=June 2010 |title=Book Review: Krause's Food and Nutrition TherapyMahanLKEscott-StumpS. Krause's Food and Nutrition Therapy. 12th ed. Philadelphia: Saunders; (2007). 1376 pp, $$149.95. {{text|ISBN}}: 978-1-4160-3401-8. |journal=Nutrition in Clinical Practice |volume=25 |issue=3 |pages=314 |doi=10.1177/0884533610362901 |issn=0884-5336}}</ref> Symptoms include dental corrosion, dysphagia, heartburn, odynophagia, regurgitation, non-cardiac chest pain, extraesophageal symptoms such as chronic cough, hoarseness, reflux-induced laryngitis, or asthma.<ref name=":2" /> In the long term, and when not treated, complications such as [[Medicine:Esophagitis|esophagitis]], esophageal stricture, and Barrett's esophagus may arise.<ref name=NIH2014/>

<!-- Cause and diagnosis -->
Risk factors include obesity, [[Medicine:Pregnancy|pregnancy]], [[Medicine:Smoking|smoking]], [[Medicine:Hiatal hernia|hiatal hernia]], and taking certain medications. Medications that may cause or worsen the disease include [[Chemistry:Benzodiazepine|benzodiazepine]]s, calcium channel blockers, tricyclic antidepressants, NSAIDs, and certain [[Medicine:Asthma|asthma]] medicines. Acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the [[Biology:Stomach|stomach]] and the esophagus. Diagnosis among those who do not improve with simpler measures may involve gastroscopy, upper GI series, [[Medicine:Esophageal pH monitoring|esophageal pH monitoring]], or esophageal manometry.<ref name=NIH2014>{{cite web |title=Acid Reflux (GER & GERD) in Adults |url=https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/all-content |website=National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) |date=5 November 2015 | archive-url=https://web.archive.org/web/20200222022538/https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/all-content | archive-date=22 February 2020 | url-status=live | access-date=21 February 2020 }}</ref>

<!-- Treatment -->
Treatment options include lifestyle changes, medications, and sometimes surgery for those who do not improve with the first two measures. Lifestyle changes include not lying down for three hours after eating, lying down on the left side, raising the pillow or bedhead height, losing weight, and stopping smoking.<ref name="NIH2014" /><ref>{{cite web |date=22 April 2019 |title=Best Sleeping Position For Acid Reflux: The Gerd Sleeping Position |url=https://www.sleepscore.com/the-one-sleeping-position-to-avoid-for-acid-reflux/ |url-status=live |archive-url=https://web.archive.org/web/20210426142440/https://www.sleepscore.com/the-one-sleeping-position-to-avoid-for-acid-reflux/ |archive-date=26 April 2021 |access-date=26 April 2021 |website=SleepScore |language=en-US}}</ref> Foods that may precipitate GERD symptoms  include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods.<ref name="AGA20082">{{cite journal |display-authors=3 |vauthors=Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, Johnson SP, Allen J, Brill JV |date=October 2008 |title=American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease |journal=Gastroenterology |volume=135 |issue=4 |pages=1383–91, 1391.e1–5 |doi=10.1053/j.gastro.2008.08.045 |pmid=18789939 |doi-access=free}}
* {{lay source |template=cite web |title=American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease |website=National Guideline Clearinghouse |url=http://www.guideline.gov/content.aspx?id=13315 |archive-url=https://web.archive.org/web/20100817113825/http://www.guideline.gov/content.aspx?id=13315 |archive-date=17 August 2010}}</ref> Medications include [[Chemistry:Antacid|antacid]]s, [[Chemistry:H2 antagonist|H<sub>2</sub> receptor blockers]], proton pump inhibitors, and prokinetics.<ref name=NIH2014/><ref name=Her2011>{{cite journal |vauthors=Hershcovici T, Fass R | title = Pharmacological management of GERD: where does it stand now? | journal = Trends in Pharmacological Sciences | volume = 32 | issue = 4 | pages = 258–64 | date = April 2011 | pmid = 21429600 | doi = 10.1016/j.tips.2011.02.007 }}</ref>

<!-- Epidemiology and history -->
In the Western world, between 10 and 20% of the population is affected by GERD.<ref name=Her2011/> It is highly prevalent in [[Earth:North America|North America]] with 18% to 28% of the population suffering from the condition.<ref>{{Cite journal |last1=El-Serag |first1=Hashem B |last2=Sweet |first2=Stephen |last3=Winchester |first3=Christopher C |last4=Dent |first4=John |date=June 2014 |title=Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review |journal=Gut |language=en |volume=63 |issue=6 |pages=871–880 |doi=10.1136/gutjnl-2012-304269 |issn=0017-5749 |pmc=4046948 |pmid=23853213}}</ref> Occasional gastroesophageal reflux without troublesome symptoms or complications is even more common.<ref name=NIH2014/> The classic symptoms of GERD were first described in 1925, when Friedenwald and Feldman commented on heartburn and its possible relationship to a hiatal hernia.<ref>{{cite book |last1=Granderath |first1=Frank Alexander |last2=Kamolz |first2=Thomas |last3=Pointner |first3=Rudolph |title=Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment |date=2006 |publisher=Springer Science & Business Media |isbn=978-3-211-32317-5 |page=161 |url=https://books.google.com/books?id=wbV09gYB6DkC&pg=PA161 |access-date=28 August 2017 |archive-date=1 January 2020 |archive-url=https://web.archive.org/web/20200101062858/https://books.google.com/books?id=wbV09gYB6DkC&pg=PA161 |url-status=live }}</ref> In 1934 gastroenterologist Asher Winkelstein described reflux and attributed the symptoms to stomach acid.<ref>{{cite book |last1=Arcangelo |first1=Virginia Poole |last2=Peterson |first2=Andrew M. |title=Pharmacotherapeutics for Advanced Practice: A Practical Approach |date=2006 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-5784-3 |page=372 |url=https://books.google.com/books?id=EaP1yJz4fkEC&pg=PA372 |access-date=28 August 2017 |archive-date=5 January 2020 |archive-url=https://web.archive.org/web/20200105150606/https://books.google.com/books?id=EaP1yJz4fkEC&pg=PA372 |url-status=live }}</ref>

== Signs and symptoms ==
=== Adults ===
The most common symptoms of GERD in adults are an acidic taste in the mouth, regurgitation, and heartburn.<ref name="Overview">{{cite journal|date=March–April 2013|title=An overview: Current clinical guidelines for the evaluation, diagnosis, treatment, and management of dyspepsia|journal=Osteopathic Family Physician|volume=5|issue=2|pages=79–85|doi=10.1016/j.osfp.2012.10.005|vauthors=Zajac P, Holbrook A, Super ME, Vogt M | display-authors=3 }}</ref> Less common symptoms include pain with swallowing/sore throat, increased salivation (also known as water brash), nausea,<ref name="Kahrilas">{{cite journal | vauthors=Kahrilas PJ | title = Gastroesophageal Reflux Disease | journal = The New England Journal of Medicine | volume = 359 | issue = 16 | pages = 1700–7 | year = 2008 | pmid = 18923172 | pmc = 3058591 | doi = 10.1056/NEJMcp0804684 }}</ref> [[Medicine:Chest pain|chest pain]], coughing, and [[Medicine:Globus pharyngis|globus sensation]].<ref name=":1">{{Cite journal |last1=Clarrett |first1=Danisa M. |last2=Hachem |first2=Christine |date=May 2018 |title=Gastroesophageal Reflux Disease (GERD) |journal=Missouri Medicine |volume=115 |issue=3 |pages=214–218 |issn=0026-6620 |pmc=6140167 |pmid=30228725}}</ref> The acid reflux can induce asthma attack symptoms like shortness of breath, cough, and wheezing in those with underlying asthma.<ref name=":1"/>

GERD sometimes causes injury to the esophagus. These injuries may include one or more of the following:
* Reflux [[Medicine:Esophagitis|esophagitis]] – inflammation of esophageal epithelium which can cause ulcers near the junction of the stomach and esophagus<ref>{{cite web|url=https://www.lecturio.com/concepts/esophagitis/|title=Esophagitis|website=The Lecturio Medical Concept Library|access-date=22 July 2021|archive-date=22 July 2021|archive-url=https://web.archive.org/web/20210722075247/https://www.lecturio.com/concepts/esophagitis/|url-status=live}}</ref>
* Esophageal strictures – the persistent narrowing of the esophagus caused by reflux-induced inflammation
* Barrett's esophagus – intestinal [[Medicine:Metaplasia|metaplasia]] (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus<ref name="pmid26526079">{{cite journal |vauthors=Shaheen NJ, Falk GW, Iyer PG, Gerson LB |display-authors=3 |title=ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus |journal=Am. J. Gastroenterol. |volume=111 |issue=1 |pages=30–50; quiz 51 |date=January 2016 |pmid=26526079 |doi=10.1038/ajg.2015.322 |pmc=10245082 |s2cid=2274838 |url=https://cdr.lib.unc.edu/downloads/zc77sw61g |access-date=7 October 2021 |archive-date=7 November 2020 |archive-url=https://web.archive.org/web/20201107061040/https://cdr.lib.unc.edu/downloads/zc77sw61g |url-status=live |doi-access=free }}</ref>
* Esophageal adenocarcinoma – a form of cancer<ref name=Kahrilas/>

GERD sometimes causes injury of the larynx (LPR).<ref>{{cite journal |vauthors=Lechien JR, Saussez S, Karkos PD |title=Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018 |journal=Curr Opin Otolaryngol Head Neck Surg |volume=26 |issue=6 |pages=392–402 |date=December 2018 |pmid=30234664 |doi=10.1097/MOO.0000000000000486 |s2cid=52307468 }}</ref><ref>{{cite journal |vauthors=Lechien JR, Bobin F, Muls V, Eisendrath P, Horoi M, Thill MP, Dequanter D, Durdurez JP, Rodriguez A, Saussez S | display-authors=3 |title=Gastroesophageal reflux in laryngopharyngeal reflux patients: Clinical features and therapeutic response |journal=Laryngoscope |volume= 130|issue= 8|pages= E479–E489|date=December 2019 |pmid=31876296 |doi=10.1002/lary.28482 | s2cid=209482485 }}</ref> Other complications can include [[Medicine:Aspiration pneumonia|aspiration pneumonia]].<ref>{{cite journal |last1=Fass |first1=R |last2=Achem |first2=SR |last3=Harding |first3=S |last4=Mittal |first4=RK |last5=Quigley |first5=E |title=Review article: supra-oesophageal manifestations of gastro-oesophageal reflux disease and the role of night-time gastro-oesophageal reflux. |journal=Alimentary Pharmacology & Therapeutics |date=December 2004 |volume=20 |issue=Suppl 9 |pages=26–38 |doi=10.1111/j.1365-2036.2004.02253.x |pmid=15527462|s2cid=23673597 |doi-access=free }}</ref>

=== Children and babies ===
GERD may be difficult to detect in infants and children since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated [[Medicine:Vomiting|vomiting]], effortless spitting up, coughing, and other respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and [[Medicine:Burping|burping]] are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD.

Of the estimated 4&nbsp;million babies born in the US each year, up to 35% of them may have difficulties with reflux in the first few months of their lives, known as 'spitting up'.<ref>{{cite web |publisher=familydoctor.org |url=http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html |title=Spitting Up in Babies |url-status=live |archive-url=https://web.archive.org/web/20081008035333/http://www.familydoctor.org/online/famdocen/home/children/parents/infants/218.html |archive-date=8 October 2008 }}</ref> About 90% of infants will outgrow their reflux by their first birthday.<ref>{{cite book |last1=Maqbool |first1=Asim |last2=Liacouras |first2=Chris A. |title=Nelson Textbook of Pediatrics |date=2020 |location=Philadelphia, PA |isbn=978-0-323-52950-1 |edition=21st |chapter=Normal Digestive Tract Phenomena}}</ref>

=== Mouth ===
[[File:GERD 1.png|thumb|Frontal view of severe tooth erosion in GERD<ref name=Ran2012>{{Cite journal|vauthors=Ranjitkar S, Kaidonis JA, Smales RJ |date=2012|title=Gastroesophageal Reflux Disease and Tooth Erosion|journal=International Journal of Dentistry|volume=2012|page=479850|doi=10.1155/2012/479850 |pmc=3238367|pmid=22194748|doi-access=free}}</ref>]]

[[File:GERD 2.png|thumb|Severe tooth erosion in GERD<ref name=Ran2012 />]]

Acid reflux into the mouth can cause breakdown of the enamel, especially on the inside surface of the teeth. A dry mouth, acid or burning sensation in the mouth, bad breath and redness of the palate may occur.<ref>{{Cite journal|last1=Romano|first1=Claudio|last2=Cardile|first2=Sabrina|date=11 August 2014|title=Gastroesophageal reflux disease and oral manifestations|journal=Italian Journal of Pediatrics|volume=40|issue=Suppl 1|pages=A73|doi=10.1186/1824-7288-40-S1-A73 |pmc=4132436 |doi-access=free }}</ref> Less common symptoms of GERD include difficulty in swallowing, water brash, chronic cough, hoarse voice, nausea and vomiting.<ref name=Ran2012/>

Signs of enamel erosion are the appearance of a smooth, silky-glazed, sometimes dull, enamel surface with the absence of perikymata, together with intact enamel along the gum margin.<ref>{{Cite journal|vauthors=Lussi A, Jaeggi T |date=March 2008|title=Erosion--diagnosis and risk factors|journal=Clinical Oral Investigations|volume=12|issue=Suppl 1 |pages=S5–13|doi=10.1007/s00784-007-0179-z |pmc=2238777|pmid=18228059}}</ref> It will be evident in people with restorations as tooth structure typically dissolves much faster than the restorative material, causing it to seem as if it "stands above" the surrounding tooth structure.<ref>{{Cite journal|vauthors=Donovan T|year=2009|title=Dental erosion|journal=Journal of Esthetic and Restorative Dentistry|volume=21|issue=6|pages=359–364|doi=10.1111/j.1708-8240.2009.00291.x |pmid=20002921}}</ref>

=== Barrett's esophagus ===

GERD may lead to Barrett's esophagus, a type of intestinal [[Medicine:Metaplasia|metaplasia]],<ref name="pmid26526079"/> which is in turn a precursor condition for [[Medicine:Esophageal cancer|esophageal cancer]]. The risk of progression from Barrett's to dysplasia is uncertain, but is estimated at 20% of cases.<ref>[http://www.gerd-library.com/dysplasia-and-barretts-esophagus/Dysplasia and Barrett's Esophagus] {{Webarchive|url=https://web.archive.org/web/20150419032727/http://www.gerd-library.com/dysplasia-and-barretts-esophagus/Dysplasia |date=19 April 2015 }}. Retrieved on 1 February 2009.</ref> Due to the risk of chronic heartburn progressing to Barrett's, EGD every five years is recommended for people with chronic heartburn, or who take drugs for chronic GERD.<ref>{{cite web |date=June 2009 |url=http://www.uptodate.com/contents/barretts-esophagus-beyond-the-basics |title=Patient information: Barrett's esophagus (Beyond the Basics) |url-status=live |archive-url=https://web.archive.org/web/20170909005636/http://www.uptodate.com/contents/barretts-esophagus-beyond-the-basics |archive-date=9 September 2017 }}</ref>

== Causes ==
[[File:GERD.png|thumb|left|A comparison of a healthy condition to GERD]]
A small amount of acid reflux is typical even in healthy people (as with infrequent and minor heartburn), but gastroesophageal reflux becomes gastroesophageal reflux disease when signs and symptoms develop into a recurrent problem. Frequent acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the [[Biology:Stomach|stomach]] and the esophagus.<ref name=NIH2014/>

Factors that can contribute to GERD:
* [[Medicine:Hiatal hernia|Hiatal hernia]], which increases the likelihood of GERD due to mechanical and motility factors.<ref name="PMC2579007">{{cite journal | vauthors=Sontag SJ | title = Defining GERD | journal = Yale J Biol Med | volume = 72 | issue = 2–3 | pages = 69–80 | year = 1999 | pmid = 10780568 | pmc = 2579007 }}</ref><ref name="pmid17573791">{{cite journal |vauthors=Piesman M, Hwang I, Maydonovitch C, Wong RK | display-authors=3 | title = Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? | journal = American Journal of Gastroenterology | volume = 102 | issue = 10 | pages = 2128–34 | date=October 2007 | doi=10.1111/j.1572-0241.2007.01348.x | pmid = 17573791 | s2cid=11965042 | url=https://zenodo.org/record/1230696 }}</ref>
* Obesity: increasing [[Body mass index|body mass index]] is associated with more severe GERD.<ref name="pmid175737910">{{cite journal |vauthors=Ayazi S, Crookes PF, Peyre CG, Hagen JA, Leers JM, Tang AL, Ungnapatanin N, DeMeester SR, Lipham JC, DeMeester, TR | display-authors=3 |title=Objective documentation of the link between gastroesophageal reflux disease and obesity |journal=American Journal of Gastroenterology |volume=102 |pages=S138–S9 |date=September 2007 | doi=10.14309/00000434-200709002-00059 }}</ref> In a large series of 2,000 patients with symptomatic reflux disease, it has been shown that 13% of changes in esophageal acid exposure is attributable to changes in body mass index.<ref name="practicalgastro-td">{{cite journal |vauthors=Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Leers JM, Oezcelik A, Banki F, Lipham JC, DeMeester TR, Crookes PF | display-authors=3 | title = Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms | journal = J. Gastrointest. Surg. | volume = 13 | issue = 8 | pages = 1440–7 | date = August 2009 | pmid = 19475461 | pmc = 2710497 | doi = 10.1007/s11605-009-0930-7 }}</ref>

Factors that have been linked with GERD, but not conclusively:
* [[Medicine:Sleep apnea|Obstructive sleep apnea]]<ref>{{cite journal |vauthors=Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R | display-authors=3 | title = Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease? | journal = Clin. Gastroenterol. Hepatol. | volume = 2 | issue = 9 | pages = 761–8 | year = 2004 | pmid = 15354276 | doi = 10.1016/S1542-3565(04)00347-7 | doi-access = free }}</ref><ref name="pmid17198758">{{cite journal |vauthors=Kasasbeh A, Kasasbeh E, Krishnaswamy G | title = Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex—a hypothetical review | journal = Sleep Med Rev | volume = 11 | issue = 1 | pages = 47–58 | year = 2007 | pmid = 17198758 | doi = 10.1016/j.smrv.2006.05.001 }}</ref>
* Gallstones, which can impede the flow of [[Biology:Bile|bile]] into the [[Biology:Duodenum|duodenum]], which can affect the ability to neutralize [[Biology:Gastric acid|gastric acid]]<ref>{{Citation |last1=Tanaja |first1=Jasmin |title=Cholelithiasis |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK470440/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29262107 |access-date=30 October 2022 |last2=Lopez |first2=Richard A. |last3=Meer |first3=Jehangir M.}}</ref>

In 1999, a review of existing studies found that, on average, 40% of GERD patients also had ''H. pylori'' infection.<ref>{{cite journal | vauthors=O'Connor HJ | title = Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management | journal = Aliment Pharmacol Ther | volume = 13 | issue = 2 | pages = 117–27 | date = Feb 1999 | pmid = 10102940 | doi = 10.1046/j.1365-2036.1999.00460.x | s2cid = 41988457 }}</ref> The eradication of ''H. pylori'' can lead to an increase in acid secretion,<ref>{{cite journal |vauthors=El-Omar EM, Oien K, El-Nujumi A, Gillen D, Wirz A, Dahill S, Williams C, Ardill JE, McColl KE | display-authors=3 | title = Helicobacter pylori infection and chronic gastric acid hyposecretion | journal = Gastroenterology | volume = 113 | issue = 1 | pages = 15–24 | year = 1997 | pmid = 9207257 | doi = 10.1016/S0016-5085(97)70075-1 }}</ref> leading to the question of whether ''H. pylori''-infected GERD patients are any different from non-infected GERD patients. A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.<ref>{{cite journal |vauthors=Fallone CA, Barkun AN, Mayrand S, Wakil G, Friedman G, Szilagyi A, Wheeler C, Ross D | display-authors=3 | title = There is no difference in the disease severity of gastro-oesophageal reflux disease between patients infected and not infected with Helicobacter pylori | journal = Aliment Pharmacol Ther | volume = 20 | issue = 7 | pages = 761–8 | date = October 2004 | pmid = 15379836 | doi = 10.1111/j.1365-2036.2004.02171.x | s2cid=922610 | doi-access = free }}</ref>

== Diagnosis ==
[[File:Peptic stricture.png|thumb|Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach: This is a complication of chronic gastroesophageal reflux disease and can be a cause of dysphagia or difficulty swallowing.]]
The diagnosis of GERD is usually made when typical symptoms are present.<ref name=Katz2012/> Reflux can be present in people without symptoms and the diagnosis requires both symptoms or complications and reflux of stomach content.<ref name=AGA2008/>

Other investigations may include esophagogastroduodenoscopy (EGD). Barium swallow [[Physics:X-ray|X-ray]]s should not be used for diagnosis.<ref name=Katz2012>{{cite journal |vauthors=Katz PO, Gerson LB, Vela MF |title=Guidelines for the diagnosis and management of gastroesophageal reflux disease |journal=American Journal of Gastroenterology |volume=108 |issue=3 |pages=308–28 |date=March 2013 |pmid=23419381 |doi=10.1038/ajg.2012.444 | doi-access=free }}</ref> [[Medicine:Esophageal motility study|Esophageal manometry]] is not recommended for use in the diagnosis, being recommended only prior to surgery.<ref name=Katz2012/> Ambulatory [[Medicine:Esophageal pH monitoring|esophageal pH monitoring]] may be useful in those who do not improve after PPIs and is not needed in those in whom Barrett's esophagus is seen.<ref name=Katz2012/> Investigation for ''H. pylori'' is not usually needed.<ref name=Katz2012/>

The current gold standard for diagnosis of GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and allows monitoring GERD patients in their response to medical or surgical treatment. One practice for diagnosis of GERD is a short-term treatment with proton-pump inhibitors, with improvement in symptoms suggesting a positive diagnosis. Short-term treatment with proton-pump inhibitors may help predict abnormal 24-hour pH monitoring results among patients with symptoms suggestive of GERD.<ref name="pmid15068979">{{cite journal |vauthors=Numans ME, Lau J, de Wit NJ, Bonis PA | title = Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics | journal = Annals of Internal Medicine | volume = 140 | issue = 7 | pages = 518–27 | date = April 2004 | pmid = 15068979 | doi = 10.7326/0003-4819-140-7-200404060-00011 | s2cid = 53088422 }}</ref>

=== Endoscopy ===
Endoscopy, the examination of the stomach with a fibre-optic scope, is not routinely needed if the case is typical and responds to treatment.<ref name=Katz2012/> It is recommended when people either do not respond well to treatment or have alarm symptoms, including dysphagia, [[Medicine:Anemia|anemia]], blood in the stool (detected chemically), [[Medicine:Asthma|wheezing]], weight loss, or voice changes.<ref name=Katz2012/> Some physicians advocate either once-in-a-lifetime or 5- to 10-yearly endoscopy for people with longstanding GERD, to evaluate the possible presence of dysplasia or Barrett's esophagus.<ref>{{citation | url = http://www.uptodate.com/contents/barretts-esophagus-beyond-the-basics | title = Patient information: Barrett's esophagus | url-status = live | archive-url = https://web.archive.org/web/20170909005636/http://www.uptodate.com/contents/barretts-esophagus-beyond-the-basics | archive-date = 9 September 2017 }}</ref>

[[Medicine:Biopsy|Biopsies]] performed during gastroscopy may show:
* Edema and basal hyperplasia (nonspecific inflammatory changes)
* Lymphocytic inflammation (nonspecific)
* Neutrophilic inflammation (usually due to reflux or ''[[Biology:Helicobacter|Helicobacter]]'' [[Medicine:Gastritis|gastritis]])
* Eosinophilic inflammation (usually due to reflux): The presence of intraepithelial eosinophils may suggest a diagnosis of eosinophilic esophagitis (EE) if eosinophils are present in high enough numbers. Less than 20 eosinophils per high-power microscopic field in the distal esophagus, in the presence of other histologic features of GERD, is more consistent with GERD than EE.<ref name=Sternberg>Mills, S (ed.) 2009.Sternberg's Diagnostic Pathology. 5th Edition. {{ISBN|978-0-7817-7942-5}}</ref>
* Goblet cell intestinal metaplasia or Barrett's esophagus
* Elongation of the papillae
* Thinning of the squamous cell layer
* [[Biology:Dysplasia|Dysplasia]]
* [[Medicine:Carcinoma|Carcinoma]]

Reflux changes that are not erosive in nature lead to "nonerosive reflux disease".

=== Severity ===
Severity may be documented with the Johnson-DeMeester's scoring system:<ref name="demeester">{{cite web
|url=https://www.asge.org/docs/default-source/education/leading-edge/9b4a3b9b-dca7-4988-8413-b43c5c403aa3.pdf
|author=Michael F. Vaezi, MD PhD MSc
|title=Testing for refractory gastroesophageal reflux disease
|access-date=20 August 2018
|archive-date=20 August 2018
|archive-url=https://web.archive.org/web/20180820234907/https://www.asge.org/docs/default-source/education/leading-edge/9b4a3b9b-dca7-4988-8413-b43c5c403aa3.pdf
|url-status=live
}}</ref>
0 – None
1 – Minimal – occasional episodes
2 – Moderate – medical therapy visits
3 – Severe – interference with daily activities

=== Differential diagnosis ===
Other causes of [[Medicine:Chest pain|chest pain]] such as heart disease should be ruled out before making the diagnosis.<ref name=Katz2012/> Another kind of acid reflux, which causes respiratory and [[Medicine:Larynx|laryngeal]] signs and symptoms, is called laryngopharyngeal reflux (LPR) or extraesophageal reflux disease (EERD). Unlike GERD, LPR rarely produces heartburn, and is sometimes called ''silent reflux''.<ref>{{Cite web |last=Stuart |first=Annie |title=Laryngopharyngeal Reflux (Silent Reflux): Causes, Treatment, Diet, and More |url=https://www.webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux |access-date=30 October 2022 |website=WebMD |language=en}}</ref> Differential diagnosis of GERD can also include dyspepsia, peptic ulcer disease, esophageal and gastric cancer, and food allergies.<ref>{{Cite journal |last1=Kellerman |first1=Rick |last2=Kintanar |first2=Thomas |date=December 2017 |title=Gastroesophageal Reflux Disease |journal=Primary Care |volume=44 |issue=4 |pages=561–573 |doi=10.1016/j.pop.2017.07.001 |issn=1558-299X |pmid=29132520}}</ref>

== Treatment ==
The treatments for GERD may include food choices, lifestyle changes, medications, and possibly surgery. Initial treatment is frequently with a [[Medicine:Proton-pump inhibitor|proton-pump inhibitor]] such as [[Chemistry:Omeprazole|omeprazole]].<ref name=Katz2012/> In some cases, a person with GERD symptoms can manage them by taking over-the-counter drugs.<ref name="OTCtreatment">{{cite report |year = 2013 |title = Using the Proton Pump Inhibitors to Treat Heartburn and Stomach Acid Reflux |publisher = Consumer Reports Best Buy Drugs |url = http://article.images.consumerreports.org/prod/content/dam/cro/news_articles/health/PDFs/Heartburn_fullreport.pdf |access-date = 21 February 2020 |url-status = live |archive-url = https://web.archive.org/web/20200222023450/https://article.images.consumerreports.org/prod/content/dam/cro/news_articles/health/PDFs/Heartburn_fullreport.pdf |archive-date = 22 February 2020}}
* {{lay source |template=cite magazine |title=Choosing a PPI to Treat Heartburn, Acid Reflux & GERD |magazine=Consumer Reports |url=http://article.images.consumerreports.org/prod/content/dam/cro/news_articles/health/PDFs/Heartburn_2pagesummary.pdf}}</ref><ref name="pmid18174564"/><ref name="pmid22778788"/> This is often safer and less expensive than taking prescription drugs.<ref name="OTCtreatment"/> Some guidelines recommend trying to treat symptoms with an [[Chemistry:H2 antagonist|H<sub>2</sub> antagonist]] before using a [[Medicine:Proton-pump inhibitor|proton-pump inhibitor]] because of cost and safety concerns.<ref name="OTCtreatment"/>

=== Medical nutrition therapy and lifestyle changes ===
Medical nutrition therapy plays an essential role in managing the symptoms of the disease by preventing reflux, preventing pain and irritation, and decreasing gastric secretions.<ref name=":2" />

Some foods such as chocolate, mint, high-fat food, and alcohol have been shown to relax the lower esophageal sphincter, increasing the risk of reflux.<ref name=":2" /> Weight loss is recommended for the overweight or obese, as well as avoidance of  bedtime snacks or lying down immediately after meals (meals should occur at least 2–3 hours before bedtime), elevation of the head of the bed on 6-inch blocks, avoidance of smoking, and avoidance of tight clothing that increases pressure in the stomach. It may be beneficial to avoid spices, citrus juices, tomatoes and soft drinks, and to consume small frequent meals and drink liquids between meals.<ref name="AGA2008" /><ref name=":2" /><ref name="Kal2006">{{cite journal |vauthors=Kaltenbach T, Crockett S, Gerson LB |year=2006 |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |doi=10.1001/archinte.166.9.965 |pmid=16682569 |doi-access=free}}</ref> Some evidence suggests that reduced sugar intake and increased fiber intake can help.<ref>{{Cite journal|vauthors=Newberry C, Lynch K |date=20 July 2017|title=Can We Use Diet to Effectively Treat Esophageal Disease? A Review of the Current Literature|journal=Current Gastroenterology Reports|volume=19|issue=8|page=38|doi=10.1007/s11894-017-0578-5 |pmid=28730507|s2cid=39516312}}</ref><ref name="AGA2008" /> Although moderate exercise may improve symptoms in people with GERD, vigorous exercise may worsen them.<ref name="Fes2009">{{cite journal |vauthors=Festi D, Scaioli E, Baldi F, Vestito A, Pasqui F, Di Biase AR, Colecchia A |date=14 April 2009 |title=Body weight, lifestyle, dietary habits and gastroesophageal reflux disease |journal=World Journal of Gastroenterology |volume=15 |issue=14 |pages=1690–701 |doi=10.3748/wjg.15.1690 |pmc=2668774 |pmid=19360912 |doi-access=free }}</ref> Breathing exercises may relieve GERD symptoms.<ref>{{cite journal |last1=Qiu |first1=K |last2=Wang |first2=J |last3=Chen |first3=B |last4=Wang |first4=H |last5=Ma |first5=C |title=The effect of breathing exercises on patients with GERD: a meta-analysis. |journal=Annals of Palliative Medicine |date=March 2020 |volume=9 |issue=2 |pages=405–413 |doi=10.21037/apm.2020.02.35 |pmid=32233626|doi-access=free }}</ref>

=== Medications ===
The primary medications used for GERD are proton-pump inhibitors, [[Chemistry:H2 antagonist|H<sub>2</sub> receptor blockers]] and antacids with or without [[Chemistry:Alginic acid|alginic acid]].<ref name=Her2011/> The use of acid suppression therapy is a common response to GERD symptoms and many people get more of this kind of treatment than their case merits.<ref name="OTCtreatment" /><ref>{{cite journal |vauthors=Gupta R, Marshall J, Munoz JC, Kottoor R, Jamal MM, Vega KJ | display-authors=3 | title = Decreased acid suppression therapy overuse after education and medication reconciliation | journal = International Journal of Clinical Practice | volume = 67 | issue = 1 | pages = 60–65 | year = 2013 | pmid = 23241049 | doi = 10.1111/ijcp.12046 | s2cid=37158104 | doi-access = free }}</ref><ref name="pmid11095327">{{cite journal |vauthors=Nardino RJ, Vender RJ, Herbert PN | title = Overuse of acid-suppressive therapy in hospitalized patients | journal = American Journal of Gastroenterology | volume = 95 | issue = 11 | pages = 3118–22 |date=November 2000 | pmid = 11095327 | doi = 10.1016/s0002-9270(00)02052-9 }}</ref><ref name="pmid22778788">{{cite journal |vauthors=Heidelbaugh JJ, Kim AH, Chang R, Walker PC | title = Overutilization of proton-pump inhibitors: What the clinician needs to know | journal = Therapeutic Advances in Gastroenterology | volume = 5 | issue = 4 | pages = 219–232 | year = 2012 | pmid = 22778788 | pmc = 3388523 | doi = 10.1177/1756283X12437358 }}</ref><ref name="pmid18174564">{{cite journal |vauthors=Forgacs I, Loganayagam A | title = Overprescribing proton pump inhibitors | journal = BMJ | volume = 336 | issue = 7634 | pages = 2–3 | year = 2008 | pmid = 18174564 | pmc = 2174763 | doi = 10.1136/bmj.39406.449456.BE }}</ref><ref name="pmid18202040">{{cite journal |vauthors=McKay AB, Wall D | title = Overprescribing PPIs: An old problem | journal = BMJ | volume = 336 | issue = 7636 | pages = 109.1–109 | year = 2008 | pmid = 18202040 | pmc = 2206261 | doi = 10.1136/bmj.39458.462338.3A }}</ref> The overuse of acid suppression is a problem because of the side effects and costs.<ref name="OTCtreatment"/><ref name="pmid11095327" /><ref name="pmid22778788" /><ref name="pmid18174564" /><ref name="pmid18202040" />

==== Proton-pump inhibitors ====
Proton-pump inhibitors (PPIs), such as [[Chemistry:Omeprazole|omeprazole]], are the most effective, followed by H<sub>2</sub> receptor blockers, such as [[Chemistry:Ranitidine|ranitidine]].<ref name=AGA2008/> If a once-daily PPI is only partially effective they may be used twice a day.<ref name=AGA2008/> They should be taken one half to one hour before a meal.<ref name=Katz2012/> There is no significant difference between PPIs.<ref name=Katz2012/> When these medications are used long-term, the lowest effective dose should be taken.<ref name=AGA2008>{{cite journal |vauthors=Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, Johnson SP, Allen J, Brill JV | display-authors=3 | title = American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease | journal = Gastroenterology | volume = 135 | issue = 4 | pages = 1383–91, 1391.e1–5 | date = October 2008 | pmid = 18789939 | doi = 10.1053/j.gastro.2008.08.045 | doi-access=free }}
* {{lay source |template=cite web |title=American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease |website=National Guideline Clearinghouse |url=http://www.guideline.gov/content.aspx?id=13315 |archive-url=https://web.archive.org/web/20100817113825/http://www.guideline.gov/content.aspx?id=13315 |archive-date=17 August 2010}}</ref> They may also be taken only when symptoms occur in those with frequent problems.<ref name=Katz2012/> H<sub>2</sub> receptor blockers lead to roughly a 40% improvement.<ref name=Tran2007>{{cite journal |vauthors=Tran T, Lowry AM, El-Serag HB | title = Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs | journal = Aliment Pharmacol Ther | volume = 25 | issue = 2 | pages = 143–53 | year = 2007 | pmid = 17229239 | doi = 10.1111/j.1365-2036.2006.03135.x | s2cid = 24358990 | doi-access = free }}</ref>

==== Antacids ====
The evidence for antacids is weaker with a benefit of about 10% ([[Medicine:Number needed to treat|NNT]]=13) while a combination of an antacid and [[Chemistry:Alginic acid|alginic acid]] (such as Gaviscon) may improve symptoms by 60% (NNT=4).<ref name=Tran2007/> [[Chemistry:Metoclopramide|Metoclopramide]] (a prokinetic) is not recommended either alone or in combination with other treatments due to concerns around adverse effects.<ref name=Her2011/><ref name=AGA2008/> The benefit of the prokinetic [[Chemistry:Mosapride|mosapride]] is modest.<ref name=Her2011/>

==== Other agents ====
[[Chemistry:Sucralfate|Sucralfate]] has similar effectiveness to H<sub>2</sub> receptor blockers; however, sucralfate needs to be taken multiple times a day, thus limiting its use.<ref name=Her2011/> [[Chemistry:Baclofen|Baclofen]], an agonist of the GABA<sub>B</sub> receptor, while effective, has similar issues of needing frequent dosing in addition to greater adverse effects compared to other medications.<ref name=Her2011/>

=== Surgery ===
The standard surgical treatment for severe GERD is the Nissen fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.<ref name=Abbas_2004>{{cite journal |vauthors=Abbas AE, Deschamps C, Cassivi SD, Allen MS, Nichols FC, Miller DL, Pairolero PC | display-authors=3 | title = The role of laparoscopic fundoplication in Barrett's esophagus | journal = Annals of Thoracic Surgery | volume = 77 | issue = 2 | pages = 393–6 | year = 2004 | pmid = 14759403 | doi = 10.1016/S0003-4975(03)01352-3 | doi-access = free }}</ref> It is recommended only for those who do not improve with PPIs.<ref name=Katz2012/> Quality of life is improved in the short term compared to medical therapy, but there is uncertainty in the benefits of surgery versus long-term medical management with proton pump inhibitors.<ref>{{cite journal|vauthors=Garg SK, Gurusamy KS |title=Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults |journal=Cochrane Database of Systematic Reviews|date=November 2015|volume=2015 |issue=11|pages=CD003243|pmid=26544951|doi=10.1002/14651858.CD003243.pub3|pmc=8278567 }}</ref> When comparing different fundoplication techniques, partial posterior fundoplication surgery is more effective than partial anterior fundoplication surgery,<ref name=Kurian2013>{{cite journal |vauthors=Kurian AA, Bhayani N, Sharata A, Reavis K, Dunst CM, Swanström LL | display-authors=3 | title = Partial anterior vs partial posterior fundoplication following transabdominal esophagocardiomyotomy for achalasia of the esophagus: meta-regression of objective postoperative gastroesophageal reflux and dysphagia | journal = JAMA Surg | volume = 148 | issue = 1 | pages = 85–90 | date = January 2013 | pmid = 23324843 | doi = 10.1001/jamasurgery.2013.409 | doi-access =  | s2cid=9136476 }}</ref> and partial fundoplication has better outcomes than total fundoplication.<ref>{{cite journal|vauthors=Ramos RF, Lustosa SA, Almeida CA, Silva CP, Matos D | display-authors=3 |title=Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? systematic review and meta-analysis |journal=Arquivos de Gastroenterologia|date=October–December 2011|volume=48|issue=4|pages=252–60|pmid=22147130|doi=10.1590/s0004-28032011000400007|doi-access=free}}</ref>

Esophagogastric dissociation is an alternative procedure that is sometimes used to treat neurologically impaired children with GERD.<ref>{{Cite journal|vauthors=Gatti C, di Abriola GF, Villa M, De Angelis P, Laviani R, La Sala E, Dall'Oglio L | display-authors=3 |date=May 2001|title=Esophagogastric dissociation versus fundoplication: Which is best for severely neurologically impaired children?|journal=Journal of Pediatric Surgery|volume=36|issue=5|pages=677–680|doi=10.1053/jpsu.2001.22935|pmid=11329564 |hdl=2108/311079|hdl-access=free}}</ref><ref name=":0">{{Cite journal|vauthors=Morabito A, Lall A, Lo Piccolo R, McCarthy H, Kauffmann L, Ahmed S, Bianchi A | display-authors=3 |date=May 2006|title=Total esophagogastric dissociation: 10 years' review|journal=Journal of Pediatric Surgery|volume=41|issue=5|pages=919–922|doi=10.1016/j.jpedsurg.2006.01.013|pmid=16677883 }}</ref> Preliminary studies have shown it may have a lower failure rate<ref>{{Cite journal|vauthors=Goyal A, Khalil B, Choo K, Mohammed K, Jones M | display-authors=3 |date=June 2005|title=Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?|journal=Journal of Pediatric Surgery|volume=40|issue=6|pages=915–919|doi=10.1016/j.jpedsurg.2005.03.004|pmid=15991170 }}</ref> and a lower incidence of recurrent reflux.<ref name=":0" />

In 2012 the U.S. [[Organization:Food and Drug Administration|Food and Drug Administration]] (FDA) approved a device called the LINX, which consists of a series of metal beads with magnetic cores that are placed surgically around the lower esophageal sphincter, for those with severe symptoms that do not respond to other treatments. Improvement of GERD symptoms is similar to those of the Nissen fundoplication, although there is no data regarding long-term effects. Compared to Nissen fundoplication procedures, the procedure has shown a reduction in complications such as gas bloat syndrome that commonly occur.<ref>{{cite journal|vauthors=Badillo R, Francis D |title=Diagnosis and treatment of gastroesophageal reflux disease|journal=World Journal of Gastrointestinal Pharmacology and Therapeutics|date=2014|volume=5|issue=3|pages=105–12|doi=10.4292/wjgpt.v5.i3.105|pmid=25133039|pmc=4133436 |doi-access=free }}</ref> Adverse responses include difficulty swallowing, chest pain, vomiting, and nausea. Contraindications that would advise against use of the device are patients who are or may be [[Medicine:Allergy|allergic]] to [[Chemistry:Titanium|titanium]], [[Chemistry:Stainless steel|stainless steel]], [[Chemistry:Nickel|nickel]], or ferrous iron materials. A warning advises that the device should not be used by patients who could be exposed to, or undergo, [[Physics:Magnetic resonance imaging|magnetic resonance imaging]] (MRI) because of serious injury to the patient and damage to the device.<ref>[https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm300790.htm Medical Device Approvals: LINX Reflux Management System - P100049] {{webarchive|url=https://web.archive.org/web/20131110133356/https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm300790.htm |date=10 November 2013 }}, U.S. Food and Drug Administration, U.S. Department of Health and Human Services, Update of 17 January 2014</ref>

Some patients who are at an increased surgical risk or do not tolerate PPIs<ref>{{cite journal|vauthors=Testoni, S, Hassan, C, Mazzoleni, G, Antonelli, G, Fanti, L, Passaretti, S, Correale, L, Cavestro, G, Testoni, P|title=Long-term outcomes of transoral incisionless fundoplication for gastro-esophageal reflux disease: systematic-review and meta-analysis|journal= Endoscopy International Open |year=2021 |volume=9(2) |issue=C2 |pages=E239–E246 |doi= 10.1055/a-1322-2209|pmid=33553587 |pmc= 7857958}}</ref> may qualify for a more recently developed incisionless procedure known as a TIF transoral incisionless fundoplication.<ref>{{cite journal|vauthors=Jain D, Singhal S |title=Transoral Incisionless Fundoplication for Refractory Gastroesophageal Reflux Disease: Where Do We Stand?|journal=Clinical Endoscopy|date=March 2016|volume=49|issue=2|pages=147–56|pmid=26878326|doi=10.5946/ce.2015.044|pmc=4821522}}</ref> Benefits of this procedure may last for up to six years.<ref>{{cite journal|vauthors=Hopkins J, Switzer NJ, Karmali S |title=Update on novel endoscopic therapies to treat gastroesophageal reflux disease: A review.|journal=World Journal of Gastrointestinal Endoscopy|date=25 August 2015|volume=7|issue=11|pages=1039–44|pmid=26322157|doi=10.4253/wjge.v7.i11.1039|pmc=4549661 |doi-access=free }}</ref>

=== Special populations ===
==== Pregnancy ====
GERD is a common condition that develops during pregnancy, but usually resolves after delivery.<ref name=":02">{{Cite journal |last1=Body |first1=Cameron |last2=Christie |first2=Jennifer A. |date=June 2016 |title=Gastrointestinal Diseases in Pregnancy: Nausea, Vomiting, Hyperemesis Gravidarum, Gastroesophageal Reflux Disease, Constipation, and Diarrhea |journal=Gastroenterology Clinics of North America |volume=45 |issue=2 |pages=267–283 |doi=10.1016/j.gtc.2016.02.005 |issn=1558-1942 |pmid=27261898}}</ref> The severity of symptoms tend to increase throughout the pregnancy.<ref name=":02" /> In pregnancy, dietary modifications and lifestyle changes may be attempted, but often have little effect. Some lifestyle changes that can be implemented are elevating the head of the bed, eating small portions of food at regularly scheduled intervals, reduce fluid intake with a meal, avoid eating three hours before bedtime, and refrain from lying down after eating.<ref name=":02" /> Calcium-based antacids are recommended if these changes are not effective; aluminum- and magnesium hydroxide-based antacids are also safe.<ref name=":02" /> Antacids that contain sodium bicarbonate or magnesium trisilicate should be avoided in pregnancy.<ref name=":02" /> Sucralfate has been studied in pregnancy and proven to be safe <ref name=":02" /> as is [[Chemistry:Ranitidine|ranitidine]]<ref>{{cite journal |vauthors=Mahadevan U, Kane S |date=July 2006 |title=American gastroenterological association institute medical position statement on the use of gastrointestinal medications in pregnancy |journal=Gastroenterology |volume=131 |issue=1 |pages=278–82 |doi=10.1053/j.gastro.2006.04.048 |pmid=16831610|doi-access=free }}</ref> and PPIs.<ref name="Katz20122">{{cite journal |vauthors=Katz PO, Gerson LB, Vela MF |date=March 2013 |title=Guidelines for the diagnosis and management of gastroesophageal reflux disease |journal=American Journal of Gastroenterology |volume=108 |issue=3 |pages=308–28 |doi=10.1038/ajg.2012.444 |pmid=23419381 |doi-access=free}}</ref>

==== Babies ====
Babies may see relief with smaller, more frequent feedings, more frequent burping during feedings, holding the baby in an upright position 30 minutes after feeding, keeping the baby's head elevated while laying on the back, removing milk and soy from the mother's diet or feeding the baby milk protein-free formula.<ref>{{cite web|url=https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412|title=Infant acid reflux - Diagnosis and treatment - Mayo Clinic|website=www.mayoclinic.org|access-date=28 September 2018|archive-date=14 May 2020|archive-url=https://web.archive.org/web/20200514231419/https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412|url-status=live}}</ref> They may also be treated with medicines such as ranitidine or proton pump inhibitors.<ref name=Tig2009>{{cite journal |vauthors=Tighe MP, Afzal NA, Bevan A, Beattie RM | title = Current pharmacological management of gastro-esophageal reflux in children: an evidence-based systematic review | journal = Paediatr Drugs | volume = 11 | issue = 3 | pages = 185–202 | year = 2009 | pmid = 19445547 | doi = 10.2165/00148581-200911030-00004 | s2cid = 42736509 }}</ref> Proton pump inhibitors, however, have not been found to be effective in this population and there is a lack of evidence for safety.<ref>{{cite journal |vauthors=van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA | display-authors=3 | title = Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review | journal = Pediatrics | volume = 127 | issue = 5 | pages = 925–35 | date = May 2011 | pmid = 21464183 | doi = 10.1542/peds.2010-2719 | s2cid=207164814 }}</ref> The role of an occupational therapist with an infant with GERD includes positioning during and after feeding.<ref name="chantelpowellot1">{{cite web|last=chantelpowellot|date=14 July 2014|title=Helping Baby with Gastroesophageal Reflux Disorder (GERD)|url=https://powellpediatrictherapy.com/2014/07/14/helping-your-baby-with-gastroesophageal-reflux-disorder-gerd/|access-date=3 May 2021|website=Occupational Therapy Services in North County San Diego|language=en|archive-date=4 May 2021|archive-url=https://web.archive.org/web/20210504155114/https://powellpediatrictherapy.com/2014/07/14/helping-your-baby-with-gastroesophageal-reflux-disorder-gerd/|url-status=live}}</ref> One technique used is called the log-roll technique, which is practiced when changing an infant's clothing or diapers.<ref name="chantelpowellot1"/> Placing an infant on their back while having their legs lifted is not recommended since it causes the acid to flow back up the esophagus.<ref name="chantelpowellot1"/> Instead, the occupational therapist would suggest rolling the child on the side, keeping the shoulders and hips aligned to avoid acid rising up the baby's esophagus.<ref name="chantelpowellot1"/> Another technique used is feeding the baby on their side with an upright position instead of lying flat on their back.<ref name="chantelpowellot1"/> The final positioning technique used for infants is to keep them on their stomach or upright for 20 minutes after feeding.<ref name="chantelpowellot1"/><ref>{{Cite journal |last=Elser |first=Heather E. |date=2012 |title=Positioning after feedings: what is the evidence to reduce feeding intolerances? |journal=Advances in Neonatal Care|volume=12 |issue=3 |pages=172–175 |doi=10.1097/ANC.0b013e318256b7c1 |issn=1536-0911 |pmid=22668689}}</ref>

== Epidemiology ==
In Western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition.<ref name=Her2011/> For instance, an estimated 3.4 million to 6.8 million Canadians have GERD. The prevalence rate of GERD in developed nations is also tightly linked with age, with adults aged 60 to 70 being the most commonly affected.<ref>{{cite journal |vauthors=Fedorak RN, Veldhuyzen van Zanten S, Bridges R | title = Canadian Digestive Health Foundation Public Impact Series: Gastroesophageal reflux disease in Canada: Incidence, prevalence, and direct and indirect economic impact | journal = Canadian Journal of Gastroenterology | volume = 24 | issue = 7 | pages = 431–4 | date = July 2010 | pmid = 20652158 | pmc = 2918483 | doi = 10.1155/2010/296584 | doi-access = free}}</ref> In the United States 20% of people have symptoms in a given week and 7% every day.<ref name=Her2011/> No data supports sex predominance with regard to GERD.<ref>{{Cite journal |last1=Kim |first1=Young Sun |last2=Kim |first2=Nayoung |last3=Kim |first3=Gwang Ha |date=30 October 2016 |title=Sex and Gender Differences in Gastroesophageal Reflux Disease |journal=Journal of Neurogastroenterology and Motility |language=en |volume=22 |issue=4 |pages=575–588 |doi=10.5056/jnm16138 |pmid=27703114 |pmc=5056567 |issn=2093-0879}}</ref>

== History ==
An obsolete treatment is [[Medicine:Vagotomy|vagotomy]] ("highly selective vagotomy"), the surgical removal of [[Biology:Vagus nerve|vagus nerve]] branches that innervate the stomach lining. This treatment has been largely replaced by medication. Vagotomy by itself tended to worsen contraction of the pyloric sphincter of the stomach, and delayed stomach emptying. Historically, vagotomy was combined with pyloroplasty or gastroenterostomy to counter this problem.<ref>{{Cite journal |last1=HINES |first1=JAMES R. |last2=GEURKINK |first2=ROBERT E. |last3=KORNMESSER |first3=THOMAS A. |last4=WIKHOLM |first4=LARRY |last5=DAVIS |first5=ROBERT P. |date=1975 |title=Vagotomy and Double Pyloroplasty for Peptic Ulcer |journal=Annals of Surgery |language=en |volume=181 |issue=1 |pages=40–46 |doi=10.1097/00000658-197501000-00010 |pmid=1119866 |pmc=1343712 |issn=0003-4932}}</ref>

== Research ==
A number of endoscopic devices have been tested to treat chronic heartburn.
* Endocinch puts stitches in the lower esophogeal sphincter (LES) to create small pleats to help strengthen the muscle. However, long-term results were disappointing, and the device is no longer sold by Bard.<ref>{{cite journal |vauthors=Jafri SM, Arora G, Triadafilopoulos G | title = What is left of the endoscopic antireflux devices? | journal = Current Opinion in Gastroenterology | volume = 25 | issue = 4 | pages = 352–7 | date = July 2009 | pmid = 19342950 | doi = 10.1097/MOG.0b013e32832ad8b4 | s2cid = 5280924 }}</ref>
* The Stretta procedure uses electrodes to apply radio-frequency energy to the LES. A 2015 systematic review and meta-analysis in response to the systematic review (no meta-analysis) conducted by SAGES did not support the claims that Stretta was an effective treatment for GERD.<ref name=Lip2015>{{cite journal|vauthors=Lipka S, Kumar A, Richter JE |title=No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis.|journal=Clinical Gastroenterology and Hepatology|date=June 2015|volume=13|issue=6|pages=1058–67.e1|pmid=25459556|doi=10.1016/j.cgh.2014.10.013}}</ref> A 2012 systematic review found that it improves GERD symptoms.<ref name=Perry2012>{{cite journal|vauthors=Perry KA, Banerjee A, Melvin WS |title=Radiofrequency energy delivery to the lower esophageal sphincter reduces esophageal acid exposure and improves GERD symptoms: a systematic review and meta-analysis.|journal=Surgical Laparoscopy, Endoscopy & Percutaneous Techniques|date=August 2012|volume=22|issue=4|pages=283–8|pmid=22874675|doi=10.1097/sle.0b013e3182582e92|s2cid=5813552}}</ref>
* NDO Surgical Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture-based implant. The company ceased operations in mid-2008, and the device is no longer on the market.
* Transoral incisionless fundoplication, which uses a device called Esophyx, may be effective.<ref>{{cite journal |vauthors=Testoni PA, Vailati C | title = Transoral incisionless fundoplication with EsophyX® for treatment of gastro-oesphageal reflux disease | journal = Digestive and Liver Disease | volume = 44 | issue = 8 | pages = 631–5 | date = August 2012 | pmid = 22622203 | doi = 10.1016/j.dld.2012.03.019 }}</ref>

== See also ==
* [[Medicine:Acid perfusion test|Acid perfusion test]]
* EndoStim Electrical Stimulation Therapy
* Esophageal motility disorder
* [[Medicine:Esophageal motility study|Esophageal motility study]]

== References ==
{{reflist|colwidth=30em}}

== Further reading ==
* {{cite journal |vauthors=Lichtenstein DR, Cash BD, Davila R, Baron TH, Adler DG, Anderson MA, Dominitz JA, Gan SI, Harrison ME, Ikenberry SO, Qureshi WA, Rajan E, Shen B, Zuckerman MJ, Fanelli RD, VanGuilder T | display-authors=3 | title = Role of endoscopy in the management of GERD | journal = Gastrointestinal Endoscopy | volume = 66 | issue = 2 | pages = 219–24 | date = August 2007 | pmid = 17643692 | doi = 10.1016/j.gie.2007.05.027 | url = https://www.asge.org/docs/default-source/education/practice_guidelines/doc-endoscopy_in_the_managment_of_gerd.pdf}}
** {{lay source |template=cite web |title=Role of endoscopy in the management of GERD |website=National Guideline Clearinghouse |url=http://www.guideline.gov/content.aspx?id=12023 |archive-url=https://web.archive.org/web/20100928094032/https://www.guideline.gov/content.aspx?id=12023 |archive-date=28 September 2010}}
* {{cite journal |vauthors=Hirano I, Richter JE | title = ACG practice guidelines: esophageal reflux testing | journal = American Journal of Gastroenterology | volume = 102 | issue = 3 | pages = 668–85 | date = March 2007 | doi = 10.1111/j.1572-0241.2006.00936.x | pmid = 17335450 | citeseerx = 10.1.1.619.3818 | s2cid = 10854440 }}
* {{cite journal | vauthors = Katz PO, Gerson LB, Vela MF | title = Guidelines for the diagnosis and management of gastroesophageal reflux disease | journal = American Journal of Gastroenterology | volume = 108 | issue = 3 | pages = 308–28 | date = March 2013 | pmid = 23419381 | doi = 10.1038/ajg.2012.444 | doi-access = free }}

{{Medical condition classification and resources
 | DiseasesDB = 23596
 | ICD10 = {{ICD10|K|21||k|20}}
 | ICD9 = {{ICD9|530.81}}
 | ICDO =
 | OMIM = 109350
 | MedlinePlus = 000265
 | eMedicineSubj = med
 | eMedicineTopic = 857
 | eMedicine_mult = {{eMedicine2|ped|1177}} {{eMedicine2|radio|300}}
 | MeshID = D005764
|ICD10CM={{ICD10CM|K21}}|ICD11={{ICD11|DA22}}}}
{{Drugs for peptic ulcer and GORD}}

[[Category:Wikipedia medicine articles ready to translate]]

{{Sourceattribution|Gastroesophageal reflux disease}}