Concept and Etiology
Gastroesophageal reflux disease or GERD is a condition where chyme
periodically backs up from the stomach into the esophagus.
Occasionally, bile can back up into the esophagus. This gastric
backflow occurs because the lower esophageal sphincter (LES) opens
resulting in decreased LES pressure or increased stomach pressure.
(Story, L., 2010, pp273-74). Once this backflow occurs the patient
will feel a burning sensation in their throat or sometimes what feels
like a lump in their throat. “GERD can result in esophagitis, strictures,
ulcerations, esophageal cancer, and chronic pulmonary disease (e.g.,
asthma)” (Story, L., 2010).
Classification:
According to NCBI (National Center for Biotechnology Information),
based on endoscopic and histopathologic appearance, GERD is
classified into three different phenotypes: non-erosive reflux disease
(NERD), erosive esophagitis (EE) which is characterized by erosions or
ulcers of the esophageal mucosa, and Barrett esophagus (BE). The
complication of BE occurs as a result of chronic pathological acid
exposure to the distal esophageal mucosa. It leads to a
histopathological change of the distal esophageal mucosa, which is
normally lined by stratified squamous epithelium to metaplastic
columnar epithelium. Barrett's esophagus is more commonly seen in
Caucasian males above 50 years, obesity, and history of smoking and
predisposes to the development of esophageal adenocarcinoma.
Clinical Manifestations:
Clinical manifestations include:
• heartburn (early)
• epigastric pain (usually after a meal or when recombinant)
• dysphagia
• nausea (usually after eating)
• dry cough
• laryngitis
• pharyngitis
• regurgitation of food
• sensation of a lump in the throat (Story, L., 2010)
Diagnostic Tests:
Diagnostic procedures for GERD consist of:
• a history
• physical examination
• barium swallow - patient is asked to drink a chalky liquid that
coats and fills the inside lining of your digestive tract. The coating
allows your doctor to see a silhouette of your esophagus, stomach
and upper intestine. You may also be asked to swallow a barium pill
that can help diagnose a narrowing of the esophagus that may
interfere with swallowing.
• EGD
• esophageal pH monitoring
• esophagus manometry - This test measures the rhythmic muscle
contractions in your esophagus when you swallow. Esophageal a a
manometry also measures the coordination and force exerted by the
muscles of your esophagus. (Mayo Clinic, 2001)
REFERENCES
Story, L. (2017). Pathophysiology: A Practical Approach (3rd Edition).
Jones & Bartlett Learning.
https://mbsdirect.vitalsource.com/books/9781284142983
Mayo Clinic, Gastroesophageal Reflux Disease, Retrieved on December
6, 2021 from https://www.mayoclinic.org/diseases-
conditions/gerd/symptoms-causes/syc-20361940
Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease.
[Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2021 Jan-. Retrieved on December 6, 2021
from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
