Gastroesophageal Reflux Disease (GERD)

exp date isn't null, but text field is

It is a disorder resulting from gastric acid-pepsin activity and other gastric contents reflux into the  esophagus  due  to  incompetent  barriers  at  the  gastroesophageal  junction  leading  to  active  inflammation of the distal third of the esophagus (prolonged contact with acid can evolve to stricture) 

Clinical presentation

  • Heartburn and regurgitation are cardinal symptoms.
  • Odynophagia, dysphagia, weight loss and bleeding
  • Chronic cough, laryngitis, pharyngitis
  • Chronic bronchitis, asthma, COPD, pneumonia, chronic sinusitis and dental decay

Investigations 

  • Endoscopic evidence mucosal ulceration
  • Histological evidence of chronic active inflammation
  • Positive finding with a gold standard 24-hours esophageal pH testing.

Pharmacological Treatment  Non-erosive, symptomatic 

A: omeprazole (PO) 20mg 24hourly for 8weeks 

OR 

S: esomeprazole (PO) 20mg-40mg 24hourly for 8weeks. 

Erosive esophagitis 

C: pantoprazole (PO) 40mg 24hourly for 8-16weeks 

For refractory cases acid suppression therapy may require continuation up to 6 months. Lifestyle  modification  and  avoidance  of  triggers  is  important  including  avoidance  of  smoking,  alcohol  and  NSAID use.    

Referral: Refer to next level center with adequate expertise and facility for refractory cases or cases  with alarming symptoms (red flags) such as bleeding, anemia, early satiety, progressive dysphagia  or odynophagia, unexplained weight loss, recurrent vomiting or family history of gastrointestinal (GI)  cancers, age ≥ 40 years.