Clinical manifestations and diagnosis of gastroesophageal reflux in adults
- Peter J Kahrilas, MD
Peter J Kahrilas, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
Gastroesophageal reflux disease (GERD) is notable for its prevalence, variety of clinical presentations, under-recognized morbidity, and substantial economic consequences.
This topic review will discuss the clinical features and diagnostic approach to patients with this disorder. The pathophysiology and medical and surgical management of GERD are presented separately. (See "Pathophysiology of reflux esophagitis" and "Medical management of gastroesophageal reflux disease in adults" and "Surgical management of gastroesophageal reflux in adults".)
Some degree of reflux is physiologic . Physiologic reflux episodes typically occur postprandially, are short-lived, asymptomatic, and rarely occur during sleep. Pathologic reflux is associated with symptoms or mucosal injury, often including nocturnal episodes. In general, the term gastroesophageal reflux disease (GERD) is applied to patients with symptoms suggestive of reflux or complications thereof, but not necessarily with esophageal inflammation. Reflux esophagitis describes a subset of patients with symptoms of GERD who also have endoscopic or histopathologic evidence of esophageal inflammation. Among untreated GERD patients, about half will have endoscopic esophagitis; among those already being treated with acid inhibitors, esophagitis is a relatively unusual finding.
Due to the broad spectrum of conditions attributable to reflux, there is little agreement as to what constitutes typical reflux disease. A consensus statement (the Montreal Classification) defines GERD as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications . According to the Montreal Working Group, heartburn is considered troublesome if mild symptoms occur two or more days a week, or moderate to severe symptoms occur more than one day a week .
There are limitations in the epidemiologic estimates of the prevalence of gastroesophageal reflux disease (GERD) as they are based upon the assumption that heartburn and/or regurgitation are the only indicators of the disease [3-5]. However, patients with objective evidence of GERD (such as esophagitis or Barrett's esophagus) do not always have heartburn and heartburn is not always sufficiently severe to be indicative of GERD .
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- CLINICAL FEATURES
- Clinical manifestations
- Upper gastrointestinal endoscopy findings
- - Histology
- Radiographic findings
- DIFFERENTIAL DIAGNOSIS
- ADDITIONAL EVALUATION
- Upper gastrointestinal endoscopy
- - Esophagitis on esophagoscopy
- Los Angeles classification
- Savary-Miller classification
- Ambulatory esophageal pH monitoring
- Esophageal manometry
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS