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Gastroesophageal reflux disease
From WikEM
Contents
Background
- Abbreviation: GERD
- 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
- Medications (mintrates, calcium-channel blockers, anticholinergics, progesterone/estrogen)
- Pregnancy
- Decreased esophageal motility
- Prolonged gastric emptying
- Anticholinergics
- Outlet obstruction
- Diabetic gastroparesis
- High-fat food
Clinical Features
Typical
- Pain and discomfort with or right after meals
- 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:
Differential Diagnosis
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- 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
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
Authors
Jordan Swartz, Claire, Ross Donaldson, Abdus Salam Khan, Neil Young
