Gastroenterology
GERD
위식도역류질환
Chronic esophageal mucosal injury from gastric content reflux
- How common
- Adults 15–25%
- Typical age
- Increases after age 40
What is it?
Transient LES relaxations and reduced LES pressure allow acidic gastric content to reflux, injuring esophageal mucosa.
Commonly affected: Distal esophagus, gastroesophageal junction
How it develops
- LES dysfunctionTransient relaxations and low resting pressure
- Reflux of gastric contentAcid, pepsin, bile reflux into esophagus
- Mucosal injurySquamous epithelial erosion, inflammation, ulcer
- ComplicationsStricture, Barrett esophagus, adenocarcinoma risk
Symptoms
- HeartburnRetrosternal burning postprandial/recumbent
- Acid regurgitationSour taste, nausea
- DysphagiaSolid food dysphagia if stricture
- Chronic cough/hoarsenessExtra-esophageal symptoms
- Nocturnal asthmaMicroaspiration trigger
How it is examined
- History (typical symptoms)Heartburn ≥2x/week suggests GERD
- Alarm featuresWeight loss, dysphagia, bleeding, anemia → endoscopy
- PPI trialEmpiric 8-week PPI trial response
Imaging
Barium esophagogram to assess stricture or hiatal hernia.
- Hiatal hernia
- Stricture
EGD is standard; 24-hr pH-impedance for quantitative assessment.
- LA grade A-D esophagitis
- Barrett esophagus
Non-surgical care
- Lifestyle modificationWeight loss, no late meals, head-of-bed elevation 15cm
- Avoid triggersCoffee, chocolate, mint, alcohol, fatty foods
- PPI standard therapyOmeprazole 20mg, esomeprazole 40mg, rabeprazole 20mg QD before meal
- H2 blockerFamotidine added at night
- Antacid/alginateGaviscon for rapid symptom relief
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed medical therapy, large hiatal hernia, young patient avoiding lifelong PPI
Procedures that may be discussed
- Laparoscopic Nissen fundoplication
- LINX magnetic sphincter augmentation
- Toupet partial fundoplication
Outlook
80–90% respond to PPI; Barrett esophagus needs surveillance.