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Gastroesophageal reflux disease (GERD)
Last reviewed: 04.07.2025
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Gastroesophageal reflux disease (GERD) is a gastroenterological disease characterized by the development of inflammatory changes in the mucous membrane of the distal esophagus and/or characteristic clinical symptoms due to repeated reflux of gastric and/or duodenal contents into the esophagus.
Incompetence of the lower esophageal sphincter allows reflux of gastric contents into the esophagus, causing acute pain. Long-term reflux can lead to esophagitis, stricture, and rarely metaplasia. Diagnosis is clinical, sometimes with endoscopy and gastric acid testing. Treatment of gastroesophageal reflux disease (GERD) includes lifestyle changes, reduction of gastric acid with proton pump inhibitors, and sometimes surgery.
ICD-10 code
- K 21.0 Gastroesophageal reflux with esophagitis
- K21.9 Gastroesophageal reflux without esophagitis.
Epidemiology of gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) is common, occurring in 30-40% of adults. It is also quite common in infants, usually appearing after birth.
The increasing relevance of the problem of gastroesophageal reflux disease is associated with the growth in the number of patients with this pathology worldwide. The results of epidemiological studies show that the frequency of reflux esophagitis in the population is 3-4%. It is detected in 6-12% of people who undergo endoscopic examination.
Studies in Europe and the United States have shown that 20-25% of the population suffers from symptoms of gastroesophageal reflux disease, and 7% experience symptoms daily. In general practice, 25-40% of people with GERD have esophagitis on endoscopic examination, but most people with GERD have no endoscopic manifestations.
According to foreign researchers, 44% of Americans suffer from heartburn at least once a month, and 7% have it daily. 13% of the adult population of the United States resort to antacids two or more times a week, and 1/3 - once a month. However, among those surveyed, only 40% of the symptoms were so pronounced that they were forced to see a doctor. In France, gastroesophageal reflux disease (GERD) is one of the most common diseases of the digestive tract. As the survey showed, 10% of the adult population experienced symptoms of gastroesophageal reflux disease (GERD) at least once a year. All this makes the study of GERD one of the priority areas of modern gastroenterology. The prevalence of GERD is comparable to the prevalence of peptic ulcer and cholelithiasis. It is believed that up to 10% of the population suffers from each of these diseases. Up to 10% of the population experiences GERD symptoms daily, 30% weekly, and 50% monthly in the adult population. In the United States, 44 million people experience symptoms of gastroesophageal reflux disease (GERD).
The true prevalence of gastroesophageal reflux disease is significantly higher than statistical data, including due to the fact that only less than 1/3 of patients with GERD seek medical attention.
[ What causes gastroesophageal reflux disease (GERD)?
The occurrence of reflux suggests lower esophageal sphincter (LES) incompetence, which may result from a general decrease in sphincter tone or recurrent transient relaxations (not associated with swallowing). Transient LES relaxation is induced by gastric dilation or subthreshold pharyngeal stimulation.
Factors that ensure normal functioning of the gastroesophageal junction include the angle of the gastroesophageal junction, contractions of the diaphragm, and gravity (i.e., upright position). Factors that contribute to reflux include weight gain, fatty foods, caffeinated carbonated beverages, alcohol, tobacco smoking, and medications. Medications that decrease LES tone include anticholinergics, antihistamines, tricyclic antidepressants, calcium channel blockers, progesterone, and nitrates.
Gastroesophageal reflux disease (GERD) can cause esophagitis, peptic ulcer of the esophagus, esophageal stricture, and Barrett's esophagus (a precancerous condition). Factors that contribute to the development of esophagitis include the caustic nature of the refluxate, the inability of the esophagus to neutralize it, the volume of gastric contents, and the local protective properties of the mucosa. Some patients, especially infants, aspirate the contents of the reflux.
Symptoms of Gastroesophageal Reflux Disease (GERD)
The most prominent symptoms of gastroesophageal reflux disease (GERD) are heartburn, with or without regurgitation of gastric contents into the mouth. Infants present with vomiting, irritability, anorexia, and sometimes signs of chronic aspiration. Adults and infants with chronic aspiration may present with cough, hoarseness, or stridor.
Esophagitis may cause pain on swallowing and even esophageal bleeding, which is usually occult but can occasionally be massive. Peptic stricture causes gradually progressive dysphagia for solid foods. Peptic ulcers of the esophagus cause pain similar to gastric or duodenal ulcers, but the pain is usually localized to the xiphoid process or high substernal region. Peptic ulcers of the esophagus heal slowly, tend to recur, and usually scar upon healing.
Where does it hurt?
What's bothering you?
Diagnosis of gastroesophageal reflux disease (GERD)
A detailed history usually suggests the diagnosis. Patients with typical features of GERD can be treated with a trial of therapy. Patients with treatment failure, persistent symptoms, or signs of complications should be evaluated. Endoscopy with cytologic examination of mucosal scrapings and biopsy of abnormal areas is the treatment of choice. Endoscopic biopsy is the only test that consistently shows the presence of columnar mucosal epithelium in Barrett's esophagus. Patients with equivocal endoscopy and persistent symptoms despite treatment with a proton pump inhibitor should have pH testing. Although barium swallow shows esophageal ulcers and peptic stricture, it is less useful for guiding treatment to reduce reflux; in addition, most patients with abnormalities will require follow-up endoscopy. Esophageal manometry can be used to guide pH probe placement and to assess esophageal motility before surgery.
What do need to examine?
What tests are needed?
Who to contact?
Treatment of gastroesophageal reflux disease (GERD)
Treatment of uncomplicated gastroesophageal reflux disease (GERD) involves raising the head of the bed 20 centimeters and avoiding the following: eating at least 2 hours before bedtime, strong stimulants of gastric secretion (eg, coffee, alcohol), certain medications (eg, anticholinergics), certain foods (eg, fats, chocolate), and smoking.
Drug treatment for gastroesophageal reflux disease (GERD) includes proton pump inhibitors. Adults may be given omeprazole 20 mg, lansoprazole 30 mg, or esomeprazole 40 mg 30 minutes before breakfast. In some cases, proton pump inhibitors may need to be given twice daily. Infants and children may be given these drugs at lower doses once daily (i.e., omeprazole 20 mg for children over 3 years, 10 mg for children under 3 years; lansoprazole 15 mg for children under 30 kg, 30 mg for children over 30 kg). These drugs may be used long-term, but the lowest dose needed to prevent symptoms should be titrated. H2 blockers (eg, ranitidine 150 mg at bedtime) or motility stimulants (eg, metoclopramide 10 mg orally 30 minutes before meals at bedtime) are less effective.
Antireflux surgery (usually laparoscopic) is performed in patients with severe esophagitis, bleeding, strictures, ulcers, or severe symptoms. For esophageal strictures, repeated balloon dilation sessions are used.
Barrett's esophagus may regress (sometimes treatment is ineffective) with medical or surgical treatment. Because Barrett's esophagus predisposes to adenocarcinoma, endoscopic surveillance for malignant transformation is recommended every 1-2 years. Surveillance is of little value in patients with mild dysplasia, but is important in severe dysplasia. Surgical resection or laser ablation may be considered as an alternative to conservative treatment of Barrett's esophagus.
How is gastroesophageal reflux disease (GERD) prevented?
Preventive measures have not been developed, so gastroesophageal reflux disease (GERD) is not prevented. Screening studies are not performed.
Historical background
The disease characterized by the reflux of gastric contents into the esophagus has been known for a long time. Mentions of some symptoms of this pathology, such as heartburn and sour belching are found in the works of Avicenna. Gastroesophageal reflux (GER) was first described by H. Quinke in 1879. Since then, many terms have changed to characterize this nosology. A number of authors call gastroesophageal reflux disease (GERD) peptic esophagitis or reflux esophagitis, but it is known that more than 50% of patients with similar symptoms do not have any damage to the esophageal mucosa at all. Others call gastroesophageal reflux disease simply reflux disease, but reflux can also occur in the venous, urinary systems, various parts of the gastrointestinal tract (GIT), and the mechanisms of occurrence and manifestation of the disease in each specific case are different. Sometimes the following diagnosis formulation is encountered - gastroesophageal reflux (GER). It is important to note that GER itself can be a physiological phenomenon and occur in absolutely healthy people. Despite its widespread prevalence and long "anamnesis", until recently GERD, according to the figurative expression of E.S. Ryss, was a kind of "Cinderella" among therapists and gastroenterologists. And only in the last decade, the widespread use of esophagogastroscopy and the advent of daily pH-metry made it possible to engage in more thorough diagnostics of this disease and try to answer many accumulated questions. In 1996, the international classification included a term (GERD), which most fully reflects this pathology.
According to the WHO classification, gastroesophageal reflux disease (GERD) is a chronic recurrent disease caused by a violation of the motor-evacuation function of the gastroesophageal zone and characterized by spontaneous or regularly recurring reflux of gastric or duodenal contents into the esophagus, which leads to damage to the distal esophagus.