-IBIS-1.5.0-
tx
digestive system
gastroesophageal reflux/dyspepsia
diagnoses

definition and etiology

definition:
irritation to esophageal mucosa caused by refluxing of stomach contents back into the esophagus; lay term is "heartburn"

etiology:
In the past, reflux was solely attributed to hiatal hernias: this is now known to be incorrect as there are many asymptomatic hiatal hernia patients and many symptomatic reflux patients that do not show hiatal hernia on x-ray.

Several factors may be involved:
• incompetent lower esophageal sphincter
• reduced sphincter pressure from alcohol, drugs, smoking, peppermint etc.
• increased volume in the stomach: e.g. after eating
• when the stomach contents are situated near to the gastroesophageal junction: from laying down or bending over, or from a hiatal hernia
• when the gastric pressure is increased: e.g. from pregnancy or general obesity

Additionally, esophagitis may be caused by infections like herpes or candida, and with mucosal damage from burns or chemicals

signs and symptoms

signs and symptoms:
• heartburn: may or may not include regurgitation of the stomach contents all or part-way back into the mouth
• odynophagia
• dysphagia: if peptic strictures are present
• hemorrhage: with esophageal ulcer or esophagitis
• pain similar to peptic or duodenal ulcer, but located in the high substernal area or by the xiphoid process may indicate esophageal ulcer
• pain may refer to arms and neck, like angina

lab findings:
• barium x-ray studies
• endoscopy and biopsy
• Heidelberg test for esophageal pH
• Bernstein test: acid perfusion of the esophagus
• manometry

course and prognosis

Untreated gastroesophageal reflux disease can develop into esophagitis as the delicate tissue of the esophagus can no longer recover from injurious effects of the stomach acid, pepsin, and bile. Peptic strictures may also develop from fibrosis in the esophageal lumen. An esophageal ulcer may also form. Some patients may be asymptomatic for years.

Conventional treatment consists of antacids and other pharmaceuticals, avoiding certain foods known to exacerbate the problem (fatty foods, coffee, chocolate, alcohol, mint, orange juice), losing weight, sleeping with the head elevated, etc.

differential diagnosis

• esophageal cancer
• angina pectoris
• hiatal hernia
• other inflammatory GI conditions, such as peptic ulcer


footnotes