Gastroesophageal reflux disease (GERD) (synonyms: Gastro-oesophageal reflux disease (GORD); Gastroesophageal reflux disease (GERD); Gastroesophageal reflux disease (reflux disease); Gastroesophageal reflux; Reflux esophagitis; Reflux disease; Reflux esophagitis; Peptic esophagitis; Esophagitis – peptic; ICD-10 K21.-: Gastroesophageal reflux disease) refers to the frequent reflux (Latin refluere = to flow back) of acidic gastric juice and other gastric contents into the esophagus (food pipe). Gastroesophageal reflux disease is one of the most common gastrointestinal (affecting the gastrointestinal tract) disorders. Gastroesophageal reflux disease is classified into:
- Primary reflux disease
- Secondary reflux disease – with underlying diseases.
Depending on endoscopic and histological findings, two clinical pictures (phenotypes) of gastroesophageal reflux disease (GERD, English : Gastroesophageal reflux disease) are distinguished:
- endoscopically negative reflux disease (non-erosive reflux disease, NERD; engl. : Non erosive reflux disease), i.e. symptomatic reflux without endoscopic and histological evidence of reflux esophagitis; patients with NERD are found in, among others:
- Children: in whom gastroesophageal reflux (GERD) is a physiologic process involving reflux (backflow) of gastric contents into the esophagus
- Hypersensitive esophagus, i.e., when heartburn is perceived, although objectively reflux events can not be detected to an increased extent (about one-third of patients)
- Functional reflux symptoms (about 2/3 of patients).
- Reflux esophagitis (erosive reflux disease, ERD; engl. : erosive reflux disease), i.e. endoscopic and/or histological evidence of reflux esophagitis/erosive reflux disease in erosive inflammatory mucosa of the distal esophagus (lower part of the esophagus).
Other subtypes that belong to GERD:
- Extra-esophageal manifestations – see this under “Symptoms – Complaints” under “Concomitant symptoms” and under “Consequential diseases”.
- Complications of GERD*
- Barrett’s esophagus*
* See under sequelae.
Sex ratio: Barrett’s syndrome (see below) – males to females is 2: 1.
Frequency peak: in the first 6 months of life and > 50 years; up to 50% of infants show regurgitations/reflux of food pulp from the stomach via the esophagus into the mouth several times a day already in the first three months (maximum: 4th month of life (67%); decreasing until the 12th month of life (5%))
The prevalence (disease frequency) is about 20-25 % – with increasing tendency (in western industrialized countries). Course and prognosis: Approximately 60 % of those affected have no endoscopically (“by mirror examination”) detectable lesions (injuries), while lesions are detectable in the remaining 40 %; 10 % of patients with reflux symptoms develop reflux esophagitis. Up to 10% of patients with reflux esophagitis develop Barrett’s syndrome (Barret’s esophagus). Barrett’s syndrome is considered a precancerous condition (possible precursor to cancer) for esophageal cancer (cancer of the esophagus), which develops into adenocarcinoma in approximately 10% of cases. Reflux of gastric contents can damage not only the esophagus (food pipe), but also supraesophageal structures (“above the esophagus). This is laryngopharyngeal reflux (LPR), or “silent reflux,” in which cardinal symptoms of gastroesophageal reflux, such as heartburn and regurgitation (backflow of food pulp from the esophagus into the mouth), are absent. Silent reflux usually occurs in the upright position. Laryngopharyngeal reflux affects the mucous membranes in the nasopharynx, larynx, trachea and bronchi. Typical complaints are clearing of the throat, hoarseness, irritable cough, burning in the throat and/or tongue, and possibly also bronchial asthma (reflux asthma) and rhinosinusitis (simultaneous inflammation of the nasal mucosa (“rhinitis”) and the mucosa of the paranasal sinuses (“sinusitis“)). Therapy depends on the stage. In early stages (I and II), conservative therapy with H2 receptor antagonists (antihistamines to inhibit gastric acid production), proton pump inhibitors (PPI; acid blockers) and antacids (agents to neutralize gastric acid) is recommended.Furthermore, the affected person should avoid reflux-promoting substances such as alcohol and smoking. From stage III, surgical intervention is usually required. In stage IV, bougienage (dilatation of stenoses (narrowings) of a hollow organ, in this case esophagus) is indicated.
