Disease Description (Causes and Symptoms)
- Definition and pathophysiology: Gastroesophageal reflux disease (GERD) is a condition in which gastric contents (gastric acid, digestive enzymes, etc.) repeatedly reflux into the esophagus due to reduced function of the lower esophageal sphincter (LES) or increased intragastric pressure, causing inflammation and symptoms in the esophageal mucosa. The main mechanisms are transient LES relaxation, reduced lower esophageal sphincter pressure, anatomical abnormalities between the lower esophagus and stomach (e.g., hiatal hernia), delayed gastric emptying, and increased intra-abdominal pressure (such as obesity, pregnancy, and ascites).
- Main causes: Overeating; fatty foods, caffeine, chocolate, mint, alcohol, and carbonated beverages; smoking; certain medications (calcium antagonists, anticholinergics, theophylline, etc.); obesity; pregnancy; hiatal hernia; and impaired gastric emptying.
- Representative symptoms:
- Typical: Heartburn, acid reflux (sour belching and bitter taste)
- Esophageal: Dysphagia (difficulty swallowing), odynophagia (pain when swallowing), chest pain
- Otorhinolaryngologic and respiratory: Chronic cough, hoarseness, globus sensation in the throat, laryngitis, worsening asthma
- Other: Dental erosion (which can cause cavities), atypical chest pain
- Commonly used diagnostic tests: Upper gastrointestinal endoscopy (to check for esophagitis and complications), 24-hour esophageal pH monitoring (to assess the acidity and frequency of reflux), and esophageal manometry (to evaluate peristalsis).
Treatment Methods
- Lifestyle modification (the basis of treatment)
- Avoid overeating and late-night meals or eating immediately before bedtime (go to bed at least 2–3 hours after eating)
- Lose weight (if obese), quit smoking, and limit alcohol consumption
- Avoid trigger foods (fatty foods, coffee, chocolate, mint, orange juice, and carbonated beverages)
- Elevate the upper body 15–20° (approximately 6–8 inches) during sleep and avoid tight-fitting clothing
- Medication treatment
- Antacids/alginates: Short-term symptom relief
- H2 receptor blockers (e.g., famotidine): Used to control mild or nighttime symptoms
- Proton pump inhibitors (PPIs, e.g., omeprazole and related drugs): First-line medications for moderate or more severe esophagitis or recurrent symptoms. Improvement is usually assessed after 4–8 weeks of treatment. Long-term maintenance or on-demand treatment may be considered when necessary.
- Prokinetic agents: Used as an adjunct in some patients (considering efficacy and adverse effects; for example, adverse effects of dopamine antagonist drugs)
- Consult a doctor when selecting, stopping, or using medications long term (potential risks of long-term PPI use have been reported, including fractures, reduced vitamin B12 absorption, and the risk of intestinal infections).
- Surgery and procedures
- Indications: Persistent symptoms or medication side effects despite medication and lifestyle therapy; complications (severe esophagitis, stricture, or bleeding); inability or unwillingness to take medication; or patient preference
- Surgical options: Laparoscopic Nissen fundoplication (total or partial fundoplication), LINX (magnetic device), etc.
- Endoscopic treatments (e.g., radiofrequency treatment) have limited evidence and are applied selectively
- Management of complications
- Esophageal stricture: Endoscopic dilation may be necessary
- Bleeding, ulcers, malabsorption, and development of Barrett’s esophagus due to long-term recurrent inflammation (surveillance is necessary) — Barrett’s esophagus can progress to esophageal adenocarcinoma depending on the degree of dysplasia, so regular endoscopy and biopsy are necessary
- Precautions (during self-management)
- Warning symptoms (requiring prompt evaluation): Severe dysphagia or inability to swallow, unexplained weight loss, melena/hematemesis, and persistent chest pain (a cardiac cause must be ruled out)
- Do not stop medication on your own without symptom relief; consult a doctor
- Develop a treatment plan considering drug interactions and underlying conditions (such as pregnancy, heart disease, and asthma)
Outpatient Visit Checklist (Including Example Questions)
- Items and records to prepare
- A list of all medications currently being taken (including prescription drugs, OTC medications, and supplements)
- Previous test results (endoscopy, 24-hour pH monitoring, esophageal manometry, etc.) and the dates of the tests
- A symptom diary (when symptoms began, frequency, time of day—especially at night—relationship to meals and posture, and triggering foods and behaviors)
- Records of weight changes, smoking and alcohol use, and pregnancy status
- Existing diagnoses (such as asthma and dental problems) and responses to previous treatments (medications and surgery)
- Materials to show the doctor during the outpatient visit
- Recent photos (e.g., if there is vomit or black stool, visit the emergency department immediately)
- A symptom scale (e.g., how many times heartburn occurs per day and the intensity of pain)
- Questions to ask yourself before the outpatient visit (key points to report to the doctor)
- When did the symptoms begin, how often do they occur, and in what situations do they worsen?
- Do nighttime symptoms interfere with sleep?
- How much have the current medications improved the symptoms? Are there any side effects?
Examples of General Questions to Ask the Doctor
- What do you think is the main cause of these symptoms?
- What tests are needed for my current symptoms (endoscopy, 24-hour pH monitoring, manometry, etc.)?
- Which medications should I take and for how long? What are the risks of long-term PPI use?
- Which lifestyle change should I make first (what should be prioritized)?
- How likely is it that surgery or a procedure will be necessary? What are the advantages and disadvantages of surgery?
- How should complications (such as strictures and Barrett’s esophagus) be monitored?
Examples of Disease-Specific Questions
- Nighttime reflux is significantly reducing my quality of life. Besides raising the head of the bed, what additional measures or medication adjustments do you recommend?
- I have chronic cough/asthma as well. How likely is it that treatment of the reflux alone will improve these symptoms? Is coordinated care with a respiratory specialist necessary?
- (For patients diagnosed with Barrett’s esophagus) What is the recommended interval for Barrett’s esophagus surveillance, and what are the treatment options if dysplasia is detected?
(Note) A considerable proportion of patients with nonerosive reflux respond well to medication and lifestyle therapy (e.g., symptom improvement rates are high with medication treatment in patients with nonerosive reflux). If severe esophagitis or complications are present, or if the condition does not respond to medication, additional tests and treatments (such as dilation, surgery, and surveillance endoscopy) are considered.