In the USA, symptoms of GERD (gastroesophageal reflux disease) occur daily in about 7% of adults and monthly in about 44%. GERD occurs more frequently in men than women (2 to 3 men compare to 1 woman). Incidence in the elderly is uncertain but appears similar to that in younger persons.

Symptoms and Signs
The most common symptom is substernal burning (heartburn), most often after meals or on reclining. Atypical chest pain, which must be differentiated from cardiac pain, can also occur.

Other symptoms include regurgitation, irritation leading to sore throat, earaches, gingivitis, hoarseness, wheezing, bronchitis, asthma, and aspiration pneumonia.

Symptoms may be worsened by eating large meals, consuming foods and beverages high in fat or caffeine, using tobacco and alcohol, reclining after eating, and gaining weight. Click Here to stop, reverse, and prevent acid reflux and heartburn now and forever.

Diagnosis
Although most diagnostic tests are unnecessary to diagnose GERD or begin treatment, they should be performed in patients with persistent or worsening symptoms or signs suggestive of tissue injury or cancer, including a typical pain, anemia, and weight loss.

Treatment
The goal of treatment is to control symptoms and heal any mucosal lesions. Most patients can be empirically managed with lifestyle changes (eg, elevating the head of the bed, reducing the size of meals, decreasing fat and caffeine intake, avoiding the supine position after eating, eliminating tobacco and alcohol use, losing weight if needed) and acid neutralization with antacids.

If relief is incomplete, treatment can include medicine such as sucralfate, H2 blockers (cimetidine, famotidine, nizatidine, ranitidine), and proton-pump inhibitors (lansoprazole, omeprazole, rabeprazole). Adjunctive therapy with a prokinetic drug (metoclopramide, cisapride) can be used if necessary.

Prokinetic drugs should be used with caution in the elderly because of potential neurologic or central nervous system disturbance. Cisapride has been associated with arrhythmias and death. GERD patients with Barrett’s esophagus require aggressive treatment with proton pump inhibitors.

Regular endoscopic surveillance is mandatory in this case. For serious cases, surgery may be required. The surgery is estimated to be 85% successful, but symptoms recur in about 10% of patients.

The morbidity rate is estimated to be 2 to 8%, and the mortality rate is about 1%. The most common complications from surgery are dysphagia and an inability to belch or vomit. I recommend: Cure your heartburn by William Lagadyn the Canadian Medical Researcher. 

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This entry was posted on Wednesday, January 17th, 2007 at 4:14 pm and is filed under Heartburn. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.