-IBIS-1.5.0-
tx
digestive system
gastroesophageal reflux/dyspepsia
diagnoses
definition and etiology
definition:
irritation to esophageal mucosa caused by refluxing of stomach contents back into the esophagus; lay term is "heartburn"
etiology:
In the past, reflux was solely attributed to hiatal hernias: this is now known to be incorrect as there are many asymptomatic hiatal hernia patients and many symptomatic reflux patients that do not show hiatal hernia on x-ray.
Several factors may be involved:
incompetent lower esophageal sphincter
reduced sphincter pressure from alcohol, drugs, smoking, peppermint etc.
increased volume in the stomach: e.g. after eating
when the stomach contents are situated near to the gastroesophageal junction: from laying down or bending over, or from a hiatal hernia
when the gastric pressure is increased: e.g. from pregnancy or general obesity
Additionally, esophagitis may be caused by infections like herpes or candida, and with mucosal damage from burns or chemicals
signs and symptoms
signs and symptoms:
heartburn: may or may not include regurgitation of the stomach contents all or part-way back into the mouth
odynophagia
dysphagia: if peptic strictures are present
hemorrhage: with esophageal ulcer or esophagitis
pain similar to peptic or duodenal ulcer, but located in the high substernal area or by the xiphoid process may indicate esophageal ulcer
pain may refer to arms and neck, like angina
lab findings:
barium x-ray studies
endoscopy and biopsy
Heidelberg test for esophageal pH
Bernstein test: acid perfusion of the esophagus
manometry
course and prognosis
Untreated gastroesophageal reflux disease can develop into esophagitis as the delicate tissue of the esophagus can no longer recover from injurious effects of the stomach acid, pepsin, and bile. Peptic strictures may also develop from fibrosis in the esophageal lumen. An esophageal ulcer may also form. Some patients may be asymptomatic for years.
Conventional treatment consists of antacids and other pharmaceuticals, avoiding certain foods known to exacerbate the problem (fatty foods, coffee, chocolate, alcohol, mint, orange juice), losing weight, sleeping with the head elevated, etc.
differential diagnosis
esophageal cancer
angina pectoris
hiatal hernia
other inflammatory GI conditions, such as peptic ulcer
footnotes