Gastroesophageal reflux disease (GERD)
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GERD Prevalence and Risk Factors
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders worldwide, with prevalence rates ranging from 18.1–27.8% in North America and significant rates in other regions as well 78. The condition is more common in individuals with risk factors such as advanced age, male sex, white race, abdominal obesity, and tobacco use . The rise in GERD cases is linked to Western lifestyle habits, increasing obesity, and changes in the prevalence of Helicobacter pylori infection 27.
GERD Symptoms and Clinical Presentation
The classic symptoms of GERD are heartburn and regurgitation, but patients may also experience chest pain, dysphagia, cough, asthma, hoarseness, and sleep disturbances 13478. GERD can present with both typical and atypical symptoms, and there is substantial overlap with other conditions such as eosinophilic esophagitis, functional dyspepsia, and gastroparesis, making diagnosis challenging 347. Alarm symptoms like dysphagia should prompt further evaluation .
Pathophysiology and Disease Mechanisms
GERD develops when the reflux of stomach contents causes troublesome symptoms or complications . The pathophysiology is multifactorial, involving a compromised anti-reflux barrier, impaired esophageal clearance, altered gastric motility, and increased visceral sensitivity 6710. The severity of GERD is primarily determined by the degree of esophageal exposure to gastric refluxate, but symptoms can also occur with normal reflux levels if there is poor epithelial resistance or heightened sensitivity 610. Psychological and neurological factors can also influence symptom perception and severity 2910.
GERD Phenotypes and Classification
GERD is now recognized as a family of syndromes rather than a single disease, with major phenotypes including non-erosive reflux disease, reflux hypersensitivity, erosive esophagitis, Barrett’s esophagus, and extraesophageal syndromes such as laryngitis, cough, asthma, and dental erosions 2579. The Montreal Consensus provides a global, patient-centered definition and classification system, distinguishing between esophageal and extraesophageal syndromes 59.
Diagnosis of GERD
Diagnosis is often based on clinical symptoms and response to acid-suppressive therapy, but more accurate diagnosis may require upper endoscopy and reflux monitoring 17. New diagnostic techniques and parameters are helping to better identify GERD phenotypes and guide management .
Management and Treatment Options
The main goals of GERD management are to relieve symptoms and prevent complications. Treatment typically involves lifestyle modifications, pharmacological therapy (mainly proton pump inhibitors, or PPIs), and, in some cases, surgery 1278. PPIs are effective for many patients, especially those with erosive esophagitis, but a significant proportion of patients continue to have symptoms despite therapy 289. In these cases, further diagnostic evaluation and personalized treatment strategies are necessary, considering factors such as anxiety, hypersensitivity, and motility disorders 2910.
Complications and Long-Term Risks
While GERD is associated with significant morbidity and reduced quality of life, mortality is rare 23. However, patients with typical GERD symptoms have an increased risk of developing esophageal adenocarcinoma 24. Other complications include esophagitis, strictures, ulcerations, Barrett’s esophagus, and extraesophageal manifestations affecting the respiratory and ENT systems 457.
Conclusion
GERD is a widespread, multifaceted disorder with a broad spectrum of symptoms and complications. Its pathophysiology is complex, involving both mechanical and sensory factors. Diagnosis and management should be individualized, with a focus on symptom relief, prevention of complications, and consideration of the diverse phenotypes and underlying mechanisms of the disease 12345678+2 MORE.
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