GERD and its

supraesophageal or
extraesophageal
manafestations

What is GERD

A condition that occurs

when the lower esophageal
sphincter (LES) does not
close properly and stomach
contents leak back, or
reflux, into the esophagus.

The LES is a ring of muscle

at the bottom of the
esophagus that acts like a
valve between the
esophagus and stomach.

What causes GERD?

No

one knows why

people get GERD.

hiatal hernia may

contribute.

Other factors that may contribute to

GERD
Alcohol

use
Overweight
Pregnancy
Smoking
Other food

What are the symptoms of GERD

Persistent heartburn and acid

regurgitation.
Belching
Waterbrash (sudden excess of
saliva)
Sour taste in the mouth
Food stuck in throat
Difficulty or pain when
swallowing
Chest pain
Hoarseness
Choking or throat tightness.
Chronic sore throat
Dry cough
Bad breath
Inflammation of the gums
Erosion of tooth enamel (the
surface of the teeth)

How is GERD diagnosed?

Review

of symptoms and a complete

physical examination, with Special
attention to alarming symptoms.

Duration & severity of symptoms

Anemia
Dysphagia (Difficulty in swollowing)
Weight loss

How is GERD treated?

Lifestyle

Changes
Medications
Surgery
Endoscopic options

Long-term complications of GERD?

Inflammation of the esophagus

Bleeding or ulcers
strictures
Barrett's esophagus and adenoarcinoma
Supraesphageal manafestations

Asthma
chronic cough
pulmonary fibrosis
ENT manafestations

Coclusions

Gastroesophageal reflux is extremely common and may

manifest with typical and atypical symptoms.

At present it is extremely difficult to establish a definite

diagnosis of extraesophageal GERD.

Typical esophageal symptoms (heartburn,

regurgitation) may be absent in a large number of
patients.

Neither the type of ENT symptoms nor the ENT findings

are of predictive value in determining underlying GER.

Coclusions

Although interesting new modalities for reflux testing are

available (capsule pH monitoring, impedance testing) it remains
to be seen whether these modalities improve diagnostic accuracy

Currently, the most cost-effective approach for most patients with

suspected reflux-related symptoms is a trial of a high-dose
proton-pump inhibitor for 3 monthes.

pH testing reserved to confirm adequate acid suppression in those

with refractory symptoms.

Although improvement in cough symptoms may be evident within

2 weeks of treatment, improvement in other ENT disorders may
require 3 or more months of therapy.

The place of Fundoplication is yet to be defined