refluxate

Refluxate is the material that rises from the stomach into the esophagus or beyond. It consists of gastric contents, including acid, pepsin, mucus, and sometimes bile; its exact composition varies with time and underlying conditions. Normally the lower esophageal sphincter prevents reflux, but when this barrier is ineffective, refluxate can reach the esophagus and, less commonly, the airways.

In gastroesophageal reflux disease (GERD) the frequency or volume of refluxate is abnormal and may irritate the mucosa. Symptoms commonly include heartburn and regurgitation, as well as a sour or metallic taste. Extraesophageal reflux can contribute to chronic cough, laryngitis, or asthma-like symptoms. The clinical presentation can be heterogeneous, especially in children, where regurgitation may be more prominent than burning pain.

Diagnosis is usually clinical but may be supported by objective testing. Ambulatory pH monitoring records esophageal acid exposure, sometimes combined with impedance testing to detect nonacid reflux. Upper endoscopy assesses for esophagitis, strictures, or Barrett’s esophagus and helps rule out alternative causes of symptoms.

Management combines lifestyle changes and pharmacotherapy. Lifestyle measures include weight reduction if overweight, elevating the head of the bed, avoiding late or large meals, and avoiding triggering foods. Proton pump inhibitors reduce gastric acid production; H2 receptor antagonists are another option. Prokinetic agents may help in select patients. Refractory cases or those with pertinent anatomy may be treated surgically with antireflux procedures such as Nissen fundoplication.

Special considerations include distinguishing regurgitation from vomiting, which involves retching, and recognizing aspiration risk, which can lead to pneumonitis or pneumonia.