Disorders of the Gastrointestinal System, 2nd Edition
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The most common presenting symptom of GERD is burning pain in the epigastric area, which patients may report as experi- encing heartburn. Often, GERD presents in the same way as a myocardial infarc- tion. Until cardiac etiologies are ruled out, the symptoms should be treated as such (Patti, 2021). Pain often occurs after a meal or when lying down, and patients may complain of fluid accumulation in the throat or having food stuck behind their breastbone. A chronic cough or hoarse- ness upon awakening may develop as a result of the reflux of gastric contents into the throat (Patti, 2021). Diagnostic tests for GERD focus on identifying the underlying cause. In addi- tion to a careful history and physical, sev- eral specific tests are conducted (IFFGD, 2022): ● Ambulatory 24-hour pH monitoring (BRAVO): Assesses the competence of the LES and measures reflux activity over 24 hours. This helps to determine if reflux is the cause of the problem, distinguishes reflux from cardiac problems, and links episodes with symptoms. ● Esophagogastroduodenoscopy (EGD) : Used to evaluate the extent of the disease and identify pathologic changes. ● Barium swallow esophagram : Used to identify if hiatal hernia is a causative factor or if the esophageal stricture is a complication of GERD. ● Esophageal manometry : Measures the strength and function of the esophagus and the musculature of the throat and esophagus. Esophageal muscle pressure, movement, coordination, and strength are assessed. Esophageal sphincters are
evaluated, with a particular focus on the LES in patients with GERD. ● Esophageal impedance-pH study : Measures how liquid moves between the stomach and esophagus. This can be a helpful test to distinguish acid from bile reflux in patients who have had normal BRAVO results but still experience GERD-like symptoms. Treatment goals for GERD are to con- trol symptoms, promote healing of the esophagus, and prevent or manage com- plications. Symptom control focuses pri- marily on lifestyle modifications such as the following (Patti, 2021): ● Dietary habits : Avoid foods that trigger GERD symptoms, such as caffeine products, chocolate, spicy foods, carbonated beverages, orange juice, alcohol, onions, fatty foods, tomato juice, and tomato sauce. Encourage small, frequent meals and avoid eating large meals, which put pressure on the LES. ● Positioning : Patients should not lie down for three hours after eating and should sleep with the head of the bed raised about 8 inches. A flat position puts pressure on the LES. ● Weight : Obesity increases abdominal pressure, pushing gastric contents into the esophagus. Even moderate weight loss can help reduce symptoms. Lifestyle modifications can promote the healing of the esophagus and control symptoms. Many patients also take med - ications for the treatment of GERD (Patti, 2021): ● Antacids neutralize acidic gastric contents. ● Foaming agents, such as Gaviscon, prevent reflux.
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