Gastroesophageal reflux disease: Difference between revisions

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==Background==
==Background==
*Abbreviation: GERD
*Affects up to 20% of population
*Affects up to 20% of population
*Assume chest pain is cardiac origin until proven otherwise
*Assume [[chest pain]] is cardiac origin until proven otherwise
 
===Causes===
===Causes===
*Decreased pressure of lower esophageal sphincter
*Decreased pressure of lower esophageal sphincter
**High-fat food
**High-fat food
**Nicotine
**Nicotine
**Ethanol
**[[Ethanol]]
**Caffeine
**Caffeine
**Meds (mintrates, CCBs, anticholinergics, progesterone/estrogen)
**Medications (mintrates, [[calcium-channel blockers]], [[anticholinergics]], progesterone/estrogen)
**Pregnancy
**[[Pregnancy]]
*Decreased esophageal motility
*Decreased esophageal motility
**Achalasia
**[[Achalasia]]
**Scleroderma
**[[Scleroderma]]
**Diabetes
**[[Diabetes]]
*Prolonged gastric emptying
*Prolonged gastric emptying
**Anticholinergics
**[[Anticholinergics]]
**Outlet obstruction
**Outlet obstruction
**Diabetic gastroparesis
**Diabetic gastroparesis
*High-fat food
*High-fat food


==Diagnosis==
==Clinical Features==
*Pain and discomfort w/ meals
===Typical===
*Chest pain w/ features similar to ACS:
*Pain and discomfort with or right after meals
**Exertional, a/w diaphoresis, N/V, radiating to arm
**typically described as burning pain
**often worse when lying flat
**dysphagia
 
===Atypical===
*[[Chest pain]] with features similar to [[ACS]]:
**Exertional, associated with diaphoresis, nausea/[[vomiting]], radiating to arm
*[[Asthma]]
*[[Pneumonia]]
*Hoarseness
*Aspiration
 
===Pediatric===
*Reflux is physiologic in infants
*Pathologic only if it causes complications, such as:
**failure to thrive/weight loss
**esophagitis
**respiratory disease: refractory [[asthma]], recurrent [[pneumonia]], apnea
**[[BRUE]]


==Differential Diagnosis==
==Differential Diagnosis==
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==Management==
==Management==
#Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
*Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
#Sleep w/ head of bed elevated
*Sleep with head of bed elevated
#Avoid eating w/in 3hr of sleep
*Avoid eating within 3hr of sleep
#PPI or H2 blocker
*[[PPI]] or [[H2 blocker]]
 
===Infants===
*Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds
**medications only if significant complications


==Disposition==
==Disposition==
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*[[Abdominal Pain]]
*[[Abdominal Pain]]


==Source==
==References==
Tintinalli
<references/>


[[Category:GI]]
[[Category:GI]]

Revision as of 11:17, 3 November 2016

Background

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

Causes

Clinical Features

Typical

  • Pain and discomfort with or right after meals
    • typically described as burning pain
    • often worse when lying flat
    • dysphagia

Atypical

Pediatric

  • Reflux is physiologic in infants
  • Pathologic only if it causes complications, such as:
    • failure to thrive/weight loss
    • esophagitis
    • respiratory disease: refractory asthma, recurrent pneumonia, apnea
    • BRUE

Differential Diagnosis

Epigastric Pain

Management

  • Avoid GERD exacerbating agents (ETOH, caffeine, nicotine, chocolate, fatty foods)
  • Sleep with head of bed elevated
  • Avoid eating within 3hr of sleep
  • PPI or H2 blocker

Infants

  • Small frequent feeds, avoid semi-supine position (e.g. carseat, carrier) right after feeds
    • medications only if significant complications

Disposition

  • Home (outpatient treatment)

See Also

References

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