RISK FACTORS FOR GERD

The risk factors associated with GERD include the following [7]:
• Psychological stress,
• Psychiatric disease,
• Alcohol
• Smoking
• Obesity (body mass index >30 kg/m2)
• An immediate family history of heartburn or gastroesophageal disease
• Use of nonsteroidal anti-inflammatory drugs


CLINICAL FEATURES

SYMPTOMS
• GERD is the probable diagnosis if the patient has heartburn (retrosternal pain) or acid regurgitation (a sour or bitter taste in mouth) as the dominant symptom.
• These symptoms are sought because their presence is associated with a probability of 89% and 95%, respectively, of GERD based on studies using esophageal pH monitoring as the reference standard [7]
• Symptoms of heartburn, regurgitation, or both, occuring after meals (particularly large or fatty meals) are highly specific
• Unusual symptoms include Hypersalivation (waterbrash), nausea and odynophagia (painful swallowing
• Extra intestinal symptoms include asthma, chest pain, noncardiac, chronic cough, dental disease, globus sensation, hoarseness, laryngitis and respiratory symptoms [7]
• Alarm Features include dysphagia, odynophagia, weight loss, hematemesis, black or bloody stools, chest pain, or choking (acid reflux causing coughing, hoarseness, or shortness of breath). Patients with alarm symptoms require immediate referral for further diagnostic testing [7]
• Complications include [7]:

• Barrett’s esophagus -- 10% to 15%
• Esophageal stricture -- 4% to 20%
• Esophageal ulceration -- 2% to 7%
• Esophageal hemorrhage -- < 2%
• Esophageal perforation -- < 0.2%
• Esophageal adenocarcinoma
• With Barrett’s esophagus -- 0.5%/y
• Without Barrett’s esophagus -- 0.07%/y


• Factors that may exacerbate or contribute to symptoms include the following:
o Gastric distension (e.g., voluminous meals)
o Supine position, particularly the right lateral decubitus position
o Bending over
o Certain foods or beverages (e.g., alcohol, caffeinated beverages, carbonated beverages, peppermint/spearmint, chocolate, citrus, high-fat foods, milk, onions, garlic, spicy foods, tomato juices)
o Excessive physical activity (e.g., running)
SIGNS
• Physical examination is not helpful [7]
• Look for any signs of extraesophageal disease, complications of advanced disease, or diseases that may present with GERD symptoms (e.g., gastric or esophageal carcinoma) [7].
HISTORY
A detailed history should be obtained from all patients regarding [7]:
• Symptom description
• Exacerbating factors
• Measures taken to relieve symptoms
• Response to previous treatments