Overview
Definition
A condition where stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus), causing symptoms or mucosal damage.
Epidemiology
Extremely common in Western populations (up to 20%).
Etiology & Risk Factors
- Transient lower esophageal sphincter (LES) relaxations
- Hiatal hernia (stomach bulges through diaphragm)
- Obesity (increased intra-abdominal pressure)
- Delayed gastric emptying
Clinical Symptoms
- Heartburn (pyrosis) typically after eating or when lying down
- Regurgitation of sour/acidic fluid
- Dysphagia (difficulty swallowing)
- Extraesophageal symptoms: Chronic cough, hoarseness, asthma exacerbations
Clinical Approach
Diagnosis
- Clinical diagnosis in classic presentations
- EGD (Endoscopy) indicated for 'alarm symptoms' (weight loss, anemia, dysphagia) or if refractory to PPIs
- 24-hour esophageal pH monitoring (Gold Standard, rarely needed)
Management
- Lifestyle modifications: Weight loss, elevate head of bed, avoid trigger foods (caffeine, alcohol, chocolate, spicy), avoid eating 3 hours before bed
- Proton Pump Inhibitors (PPIs) are first-line medical therapy
- H2-receptor antagonists (e.g., Famotidine) for mild symptoms
- Nissen fundoplication (surgical wrapping of stomach around LES) for severe/refractory cases
Complications
- Erosive esophagitis
- Esophageal strictures
- Barrett's Esophagus (metaplasia of squamous to columnar epithelium)
- Esophageal Adenocarcinoma