• (NB some reflux is perfectly normal)

    • Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus.

    • Retrograde flow of gastric juice (GASTRIC ACID) and/or duodenal contents (BILE ACIDS; PANCREATIC JUICE) into the distal ESOPHAGUS

    • Commonly due to incompetence of the LOWER ESOPHAGEAL SPHINCTER.

    • Gastric regurgitation is an extension of this process with retrograde flow into the PHARYNX or MOUTH.

    • Los Angeles classification

      • 1: 1 mucosal break <5mm

      • 2: > 5mm long

      • 3: Continuous between 2 mucosal folds

      • 4: Break >75% of mucosal circumference

Risk Factors

  • Scleroderma

    • Fatty diet

    • Old age

    • Hiatus hernia

    • Obesity

    • Psychological stress?

Differential diagnosis


    • Incidence: 36% in U.S.

    • Most take OTC medications and do not seek medical help

    • GERD patients wait 1-3 years before seeing a doctor


    • Transient relaxation of lower esophageal sphincter

Clinical features

    • Heartburn (Initial GERD symptom)

      • Location: Epigastric and retrosternal Chest Pain

      • Characteristic: Caustic or stinging

      • No radiation to the back

    • Acid Regurgitation (Water Brash or Pyrosis)

      • Suggests progressing GERD

      • Provoked by lying supine or leaning forward

      • Regurgitation of digested food or clear burning fluid

      • Undigested food suggests alternative diagnosis

        • Achalasia

        • Esophageal Diverticulum

    • Difficult swallowing (Dysphagia)

      • See Dysphagia from Esophageal Cause

      • Mechanical obstruction of solid foods

        • Suggests peptic stricture

      • Liquid obstruction suggests alternative diagnosis

        • Neuromuscular disorder

        • Neoplasm

        • Esophageal diverticulum

    • Atypical

    • Signs: Orofacial effects of chronic Acid Reflux

    • Chronic Sinusitis




a) conservative

    • Drink 8 glasses (8 ounces) non-caffeinated fluid daily

    • Decrease provocative foods

      • Decrease or eliminate caffeine

      • Avoid spicy foods

      • Avoid milk products toward end of day

      • Avoid chocolate

      • Avoid fatty foods

  • Tobacco Cessation

    • No eating food 2-3 hours before bedtime

    • Elevate head of bed to 30 degrees

      • Place 6-8 inch blocks under legs at head of bed

      • Place Styrofoam wedge under mattress

    • Symptomatic therapy for mild intermittent symptoms

b) medical

    • Consider H2 Blocker maintenance therapy

    • Medications not found to be beneficial

      • Sucralfate (Carafate) offers minimal benefit in GERD

    • Acronym: PHAD:

      • Proton pump inhibitors

      • H2 antagonists

      • Antacids

      • Dopamine antagonists prokinetic agents

c) surgical