Gastroesophageal Reflux Disease



Gastroesophageal Reflux Disease

Introduction

Gastroesophageal reflux disease (GERD) is a motility disorder in which abnormal reflux of gastric contents into the esophagus causes mucosal damage, heartburn, and other clinical manifestations. Although the prevalence of GERD does not appear to increase with age. The pathogenesis of GERD is multifactorial; factors that lead to GERD include abnormal lower esophageal sphincter pressure, altered esophageal mucosal resistance, delayed esophageal clearance, and delayed gastric emptying.

Facts and Figures

GERD is usually diagnosed in persons over age 40 and is common in older adults. GERD affects 14-20% of adults in the United States; the prevalence of GERD among older adults is similar to that among younger persons. It is seen more commonly in older women than older men (15% versus 8%).

Risk Factors

The effect of age as a risk factor for GERD is unclear; some studies have shown an increased risk with increasing age, others have found no association, and others show an increasing incidence up to ages 55-70 years and then a decline. A number of risk factors for GERD are more common in older adults. Older adults tend to take more medications than younger adults; certain medications may contribute to the development of GERD (e.g., calcium channel blockers, ß-blockers, anticholinergics, benzodiazepines, theophylline, nitrates, barbiturates, narcotics, nonsteroidal anti-inflammatory drugs [NSAIDs], bisphosphonates, and potassium supplements). Older adults are also more likely to have hiatal hernias and/or neurologic diseases that may affect esophageal and gastrointestinal motility and/or tone (e.g., diabetes mellitus, Parkinson disease, stroke, and dementia).

Signs and Symptoms/Clinical Presentation

Older adults with GERD are less likely to present with classic symptoms, including heartburn and/or regurgitation. This population is more likely to present with dysphagia, vomiting, chest pain, prolonged laryngitis, chronic cough, hoarseness, postprandial fullness, and belching.

Assessment

Patient History

Assess risk factors, including medical history and medication use for the patient previously. Esophagogastroduodenoscopy with biopsy will diagnose esophagiti, Esophageal pH monitoring will assess for the presence of reflux, Upper GI series or barium swallow will evaluate for anatomic abnormalities, including stricture and hiatal hernia, Bronchoscopy is performed if reflux into lungs is suspected, Esophageal manometry will assess LES pressure, Radionuclide scintigraphy will measure gastric emptying. These are the following things that should be considered before patient treatment.

Treatment Goals

Treatment goals must be identified after assessing patient's history.

Provide Supportive Care and Monitor for Complications

Administer prescribed medications, which may include, antacids to neutralize gastric acid, PPIs (e.g., omeprazole, lansoprazole) and H2 blockers (e.g., ranitidine, cimetidine, famotidine) ...