Magazine article Drug Topics

Continuing Education: Quelling Gastroesophageal Reflux Disease

Magazine article Drug Topics

Continuing Education: Quelling Gastroesophageal Reflux Disease

Article excerpt



Digestive diseases affect between 60 million and 70 million people in the United States each year but result in fewer than 250,000 deaths (< 1%). Nevertheless, digestive diseases are responsible for approximately 13% of all hospitalizations, account for approximately 14% of all diagnostic and therapeutic procedures, and are the genesis of more than 50 million physician visits, resulting in a cost exceeding $100 billion annually. Therefore, although digestive diseases are rarely fatal, the time, energy, and costs devoted to the diagnosis and treatment of these diseases are significant.

There are many different categories of digestive disorders. One of the most prevalent and costly digestive disorders is gastroesophageal reflux disease (GERD). Over the past few decades, a substantial shift has occurred in the epidemiology of digestive disorders, to where GERD and gastric ulcers in older persons are now more common than duodenal ulcer disease, once the predominant digestive disorder. This shift is more than likely a reflection of the discovery and treatment of H. pylori infections, the predominant cause of duodenal ulcers in young persons, and an increase in the use of nonsteroidal anti-inflammatory drugs (NSAIDs), especially in the elderly.

A major contributor to the overall costs of acid-related GI disorders, GERD can significantly affect an individual's normal daily activities and productivity but is rarely life threatening. GERD occurs when the lower esophageal sphincter (LES)-the muscle connecting the esophagus with the stomach-becomes inappropriately weak or relaxed and allows fluid from the stomach contents to "reflux" into the esophagus. As the acidic reflux material comes in contact with the unprotested epithelial cells of the esophagus, it produces the pain sensation referred to as heartburn or acid indigestion. It is important to point out that it is normal to experience occasional heartburn and acid indigestion, and that, in general, it is only when the frequency of reflux condition goes well beyond the "occasional bouts" that it is referred to as GERD. Heartburn and indigestion are only symptoms of GERD.

Risks and occurrence

Certain individuals appear to be more prone to acid reflux symptoms than others. GERD is a common condition in infants (< 12 months old). "Spitting up" is simply another term for gastroesophageal reflux (GER) in the infant. This condition usually resolves within one to two years after birth; however, certain methods can be used to control this symptom in most infants until the reflux resolves by itself. With adults, white males are more at risk for Barrett's esophagus and adenocarcinoma than are other populations. No sex predilection exists; however, males tend to develop esophagitis (2:1-3:1) and Barrett's esophagus (10:1) more frequently than females. GERD occurs in all age groups, but its prevalence increases significantly after age 40. In addition, individuals with a family history of GERD have an increased risk, as do individuals with a higher than normal frequency of hiatal hernia. Studies have identified an autosomal dominant hereditary pattern in severe pediatric GERD cases, suggesting a possible genetic tendency for familial occurrence of GERD.

Other risk factors include decreased saliva volume, increased acid secretion, altered esophageal buffering, esophageal motility disorder, hiatal hernia, obesity, spinal cord injury, and gastroparesis, all of which may predispose individuals to reflux and GERD. In some cases, individuals with Zollinger-Ellison syndrome, thyroid disease, diabetes, scleroderma, or mixed connective disorders are at risk, since they may develop esophageal motility dysfunction and impaired peristalsis that hinder acid clearance. GERD and symptoms of reflux are prevalent with pregnancy, obesity, frequent prone positioning, and chronic constipation, all of which increase intra-abdominal pressure. …

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