03 December 2025, Wednesday

What is Gastroesophageal Reflux

Gastroesophageal Reflux Disease (GERD) is a chronic relapsing disease caused by the pathological reflux of gastric contents (acid, pepsin, bile) into the esophagus, leading to characteristic symptoms (heartburn, regurgitation) and/or the development of esophagitis and other complications.

 

Causes and Risk Factors

The pathophysiology of GERD includes:

    •    Decreased lower esophageal sphincter (LES) tone — the main mechanism
    •    Esophageal motility disorders (delayed acid clearance)
    •    Delayed gastric emptying
    •    Increased intra-abdominal pressure

Clinically significant risk factors:

    •    Obesity, especially abdominal (increases intra-abdominal pressure)
    •    Pregnancy — hormonal (progesterone) and mechanical changes
    •    Smoking — reduces LES tone
    •    Alcohol, chocolate, coffee, fatty and spicy foods
    •    Certain medications: calcium channel blockers, nitrates, anticholinergic agents
    •    Hiatal hernia

 

Main Symptoms

Symptoms are divided into:

Typical (esophageal):

    •    Heartburn (burning sensation behind the sternum, often worsened by lying down or after eating)
    •    Acid regurgitation (return of acidic contents into the mouth)

Atypical (extraesophageal):

    •    Chest pain not related to the heart
    •    Chronic cough
    •    Hoarseness, especially in the morning
    •    Postnasal drip, a feeling of a "lump" in the throat
    •    Dysphagia (difficulty swallowing)

 

Diagnostics

1. Clinical assessment (for typical symptoms):

    •    Patients with classic symptoms can be prescribed empirical PPI therapy without further diagnostics.

2. Instrumental methods:

    •    Fibrogastroscopy (EGD) — recommended for:
    •    Alarm symptoms (dysphagia, anemia, weight loss, bleeding)
    •    Lack of effect from PPIs
    •    Age >50 years with new symptoms
    •    Suspicion of complications (erosive esophagitis, Barrett's esophagus)
    •    24-hour esophageal pH-impedance monitoring — the "gold standard" for confirming reflux in case of a doubtful diagnosis or normal endoscopy
    •    Esophageal manometry — to rule out motor disorders (especially before surgical treatment)

 

Modern methods of treatment

1. Non-drug measures (recommended for all patients):

    •    Weight control
    •    Elevation of the head of the bed (by 15–20 cm)
    •    Avoiding eating 2–3 hours before bedtime
    •    Excluding trigger foods: chocolate, coffee, mint, fatty foods, alcohol
    •    Smoking cessation

2. Drug treatment:

    •    Proton pump inhibitors (PPIs) — first-line therapy

3. Surgical treatment:

    •    Nissen fundoplication (laparoscopic)
    •    Indications: ineffectiveness of medications, refusal of long-term therapy, presence of complications
    •    Magnetic sphincter implant (LINX)

 

Complications and prevention

 

Complications of GERD:

    •    Erosive esophagitis (according to the Los Angeles classification A–D)
    •    Esophageal strictures
    •    Barrett's esophagus — epithelial metaplasia, associated with esophageal adenocarcinoma
    •    Aspiration pneumonitis, bronchial asthma

Prevention:

    •    Maintenance PPI therapy
    •    Eradication of risk factors
    •    Screening for Barrett's esophagus in men >50 years with long-term GERD and risk factors

 

GERD and pregnancy

The frequency of reflux in pregnancy is up to 50–80% of women, especially in the II–III trimesters.

Mechanisms:

    •    Increased progesterone levels → decreased LES tone
    •    Increased intra-abdominal pressure

When to see a doctor

    •    Heartburn ≥2 times a week, especially if antacids are ineffective
    •    Chest pain not related to food intake
    •    Difficulty swallowing (dysphagia)
    •    Weight loss, anemia
    •    Relapses after discontinuation of PPI therapy
    •    Atypical symptoms (hoarseness, cough, asthma)