Gastroesophageal reflux disease: Difference between revisions
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* Hernia < 2cm 27% | * Hernia < 2cm 27% | ||
* Hernia > 2cm 35% | * Hernia > 2cm 35% | ||
==Signs/symptoms== | |||
Patients with GERD may have heartburn or reflux symptoms; however, these symptoms may be due to [[peptic ulcer disease]].<ref name="pmid8224642">{{cite journal |author=Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR |title=Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy |journal=Gastroenterology |volume=105 |issue=5 |pages=1378–86 |year=1993 |pmid=8224642 |doi=}}</ref><ref name="pmid2021764">{{cite journal |author=Johnsen R, Bernersen B, Straume B, Førde OH, Bostad L, Burhol PG |title=Prevalences of endoscopic and histological findings in subjects with and without dyspepsia |journal=BMJ |volume=302 |issue=6779 |pages=749–52 |year=1991 |pmid=2021764 |doi=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=2021764 Fulltext]</ref> | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 00:08, 12 October 2007
Cause/etiology
Gastroesophageal reflux disease is a multifactorial disease.[1]
Hiatal hernia
The presence of a hiatal hernia correlates with abnormal 24 ph monitoring. In one study the presence of abnormal ph monitoring was:[2]
- No hernia 18%
- Hernia < 2cm 27%
- Hernia > 2cm 35%
Signs/symptoms
Patients with GERD may have heartburn or reflux symptoms; however, these symptoms may be due to peptic ulcer disease.[3][4]
Diagnosis
There is no single test that can identify all patients with GERD. However, most patients with have abnormalities of either 24 hour ph monitoring or the Berstein test.[1]
Radiology
Hiatal hernia
The accuracy of a radiologic hiatal hernia predicts abnormal 24 hour ph monitoring is:[2] Hernia of any size:
- sensitivity 74%
- specificity 42%
Hernia at least 2cm:
- sensitivity 40%
- specificity 74%
Reflux on manual stomach compression or valsalva
The accuracy of reflux during the upper gastrointestinal series predicts endoscopic esophagitis is:[5]
Spontaneous reflux:
- sensitivity 15%
- specificity >75(?)%
Reflux during abdominal compression:
- sensitivity 40%
- specificity 74%
Treatment
Avoid tight fitting garments.
Medications
Some patients will be able to take 2-4 week course of medications as needed.[6]
15% of patients may be able to stop medications after symptoms are controlled.[7]
As needed versus scheduled
Step up or step down
References
- ↑ 1.0 1.1 Howard PJ, Maher L, Pryde A, Heading RC (1991). "Symptomatic gastro-oesophageal reflux, abnormal oesophageal acid exposure, and mucosal acid sensitivity are three separate, though related, aspects of gastro-oesophageal reflux disease". Gut 32 (2): 128–32. PMID 1864528. [e]
- ↑ 2.0 2.1 Ott DJ, Gelfand DW, Chen YM, Wu WC, Munitz HA (1985). "Predictive relationship of hiatal hernia to reflux esophagitis". Gastrointestinal radiology 10 (4): 317–20. PMID 4054494. [e]
- ↑ Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR (1993). "Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy". Gastroenterology 105 (5): 1378–86. PMID 8224642. [e]
- ↑ Johnsen R, Bernersen B, Straume B, Førde OH, Bostad L, Burhol PG (1991). "Prevalences of endoscopic and histological findings in subjects with and without dyspepsia". BMJ 302 (6779): 749–52. PMID 2021764. [e] Fulltext
- ↑ Fransson SG, Sökjer H, Johansson KE, Tibbling L (1989). "Radiologic diagnosis of gastro-oesophageal reflux". Acta radiologica (Stockholm, Sweden : 1987) 30 (2): 187–92. PMID 2923744. [e]
- ↑ Bardhan KD, Müller-Lissner S, Bigard MA, et al (1999). "Symptomatic gastro-oesophageal reflux disease: double blind controlled study of intermittent treatment with omeprazole or ranitidine. The European Study Group". BMJ 318 (7182): 502–7. PMID 10024259. [e]
- ↑ Inadomi JM, Jamal R, Murata GH, et al (2001). "Step-down management of gastroesophageal reflux disease". Gastroenterology 121 (5): 1095–100. PMID 11677201. [e]