Relevant Physiology

Etiology & Pathogenesis

• Stomach Physiology

• Key Cause: transient relaxation of the lower esophageal sphincter (LES)

  

• Hiatal Hernia → common incidental finding, is associated with GERD

  • if develops GERD, often refractory and may qualify for surgery Nissen Fundoplication

Presentation

Signs and Symptoms

Highlight = specific, good for screening

Classic Esophageal Symptoms (3)

• GER : Food Regurgitation, CP - Chest Pain with burning snesation (Heartburn)

Extra-Esophageal Symptoms (6)

• GERD act as a co-factor → aspiration & neurally mediated (less specific)
  • Globus
  • Hoarse voice/Dysphonia
  • Throat clearing
  • Cough
  • Asthma
  • Dental erosions
• Complications (4)
  • Esophagitis
  • Peptic Stricture
  • Barrett’s esophagus → consider risk factors
  • Esophageal adenocarcinoma

DDx

• MUST rule out CAD if present withCP - Chest Pain
  • May not pursue additional investigations only if Heartburn and Food Regurgitation are the ONLY presenting symptoms
  • ‣
• Other causes
  • Scleroderma → Esophageal dysmotility
• Alarming features → Complications or alternative diagnosis
  • Dysphagia
  • Weight loss
  • Anemia (↓Hb)
  • N/V - Nausea/vomitting
  • UGIB - Upper GI Bleed → Melena

Management

Behavioural/Preventative