However, endoscopy is recommended in the presence of alarm symptoms and for screening of patients at high risk for complications (i.e. Upper endoscopy is not required in the presence of typical GERD symptoms. Alarm symptoms may suggest a possible underlying malignancy. It is important to screen patients for alarm symptoms associated with GERD as these should prompt endoscopic evaluation. 15 Some GERD patients may also experience chronic nausea and vomiting. 14 Furthermore, acid reflux may trigger bronchospasm, which can exacerbate underlying asthma, thereby leading to cough, dyspnea, and wheezing. 14 The cause of globus is not well understood but it is thought that exposure of the hypopharynx to acid leads to increased tonicity of the upper esophageal sphincter (UES). It is not uncommon for patients with GERD to complain of a feeling of fullness or a lump in the back of their throat, referred to as globus sensation. Extraesophageal symptoms are more likely due to reflux into the larynx, resulting in throat clearing and hoarseness. 13 A good clinical history may elicit GERD symptoms in patients with non-cardiac chest pain pointing to GERD as a potential etiology.Īlthough classic symptoms of GERD are easily recognized, extraesophageal manifestations of GERD are also common but not always recognized. 12, 13 It is important to distinguish between the underlying cause of the chest pain because of the potentially serious implications of cardiac chest pain and varied diagnostic and treatment algorithms based on etiology. Notably, GERD is a common cause of non-cardiac chest pain. Heartburn is also often associated with a sour taste in the back of the mouth with or without regurgitation of the refluxate. However, only a small percentage of reflux events are symptomatic. Heartburn is a burning sensation in the chest, radiating toward the mouth, as a result of acid reflux into the esophagus. The classic and most common symptom of GERD is heartburn. Other factors include reduced lower esophageal sphincter (LES) pressure, hiatal hernias, impaired esophageal clearance, and delayed gastric emptying. 10 While these are physiologic in nature, there is an increase in frequency in the postprandial phase and they contribute greatly to acid reflux in patients with GERD. TLESRs are brief moments of lower esophageal sphincter tone inhibition that are independent of a swallow. The most common cause is transient lower esophageal sphincter relaxations (TLESRs). The factors influencing GERD are both physiologic and pathologic. Gastroesophageal reflux is primarily a disorder of the lower esophageal sphincter (LES) but there are several factors that may contribute to its development. Recreational physical activity appears to be protective, except when performed post-prandially. 6 – 8 Eating habits may also contribute to GERD, including the acidity of food, as well as size and timing of meals, particularly with respect to sleep. Risk factors for GERD include older age, excessive body mass index (BMI), smoking, anxiety/depression, and less physical activity at work. 5 This cost difference is likely due to higher morbidity in GERD patients and the higher cost of managing complications of inappropriately treated GERD. While GERD medications are not particularly expensive, the cost of treating GERD patients has been deemed 2-fold more costly than comparable individuals without GERD. 4 Successful treatment of GERD symptoms has been associated with significant improvement in quality of life, including decreased physical pain, increased vitality, physical and social function, and emotional well-being. GERD is an important health concern as it is associated with decreased quality of life and significant morbidity. 3 Diagnosis of GERD is typically based on classic symptoms and response to acid suppression after an empiric trial. 2 According to the Montreal definition, GERD is a condition of troublesome symptoms and complications that result from the reflux of stomach contents into the esophagus. 1 Approximately half of all adults will report reflux symptoms at some time.
Gastroesophageal reflux disease (GERD) is a very common digestive disorder worldwide with an estimated prevalence of 18.1–27.8% in North America.
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