GERD

Gastroesophageal reflux disease (GERD) is a chronic condition in which reflux of stomach contents into the distal esophagus causes troublesome symptoms or esophageal injury. It is commonly related to transient relaxation of the lower esophageal sphincter, and may be worsened by factors such as hiatal hernia, impaired esophageal clearance, or reduced mucosal resistance. Risk factors include obesity, smoking, pregnancy, certain medications, and dietary triggers.

Typical symptoms of GERD are heartburn and acid regurgitation. Less specific or extraesophageal manifestations can include chronic cough, laryngitis, hoarseness, postnasal drainage, chest discomfort, and dental erosion. Chest pain may mimic cardiac symptoms and warrants evaluation when sudden or atypical.

Diagnosis is largely clinical, guided by symptom patterns and response to therapy. Endoscopy is recommended for patients with alarm features (dysphagia, weight loss, bleeding) or long-standing disease, to assess mucosal injury or complications. Ambulatory pH monitoring or impedance testing can be used when the diagnosis is uncertain or to evaluate refractory symptoms.

Management aims to relieve symptoms, heal mucosal injury, and prevent complications. Lifestyle modifications are foundational and include weight loss if needed, elevating the head of the bed, avoiding late meals and triggers, smoking cessation, and limiting alcohol. Pharmacologic therapy is commonly employed: proton pump inhibitors (PPIs) are first-line for moderate to severe or erosive disease; H2 receptor antagonists or antacids may be used for milder symptoms or on a as-needed basis. In selected cases, surgical or endoscopic procedures such as laparoscopic Nissen fundoplication or alternative therapies may be considered.

Complications can include esophagitis, esophageal stricture, Barrett’s esophagus, and rarely esophageal adenocarcinoma. GERD is a prevalent condition that affects quality of life and may require long-term management.