Gastroesophageal reflux disease (GERD) happens when stomach acid flows back into the esophagus often enough to cause symptoms or damage. It is common, and most patients improve with lifestyle changes and acid-lowering medicine.
Key symptoms
- Heartburn: burning behind the breastbone after meals or lying down
- Sour taste or regurgitation of food
- Chronic cough, hoarse voice or throat clearing
- Chest discomfort that is not from the heart
What you find on exam
- Usually normal
- Weight and BMI
- Upper belly tenderness
- Signs of anemia or weight loss as alarm clues
Tests
- Diagnosis from typical symptoms and response to a proton pump inhibitor
- ECG and heart workup if chest pain could be cardiac
- Upper endoscopy if alarm symptoms or no response to treatment
- pH monitoring if the diagnosis is unclear
Treatment basics
- Lifestyle: weight loss, raise the head of the bed, avoid late meals and trigger foods, stop smoking
- Antacids or an H2 blocker such as famotidine for mild symptoms
- Proton pump inhibitor such as omeprazole before breakfast for 8 weeks
- Step down to the lowest dose that controls symptoms
- Surgery for selected patients with severe or refractory reflux
Red flags
- Trouble or pain swallowing
- Weight loss, vomiting blood or black stools
- Anemia or symptoms starting after age 60
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.