LECTURE 2: GASTROESOPHAGEAL REFLUX DISEASE (GERD)
There is no one single cause of gastroesophageal reflux disease (GERD). It can occur
when there is reflux of acidic gastric contents into the esophagus.
Predisposing conditions include hiatal hernia, incompetent lower esophageal sphincter,
decreased esophageal clearance (ability to clear liquids or food from the esophagus into
the stomach) resulting from impaired esophageal motility, and decreased gastric
A complication of GERD is Barrett’s esophagus (esophageal metaplasia), which is
considered a precancerous lesion that increases the patient’s risk for esophageal cancer.
Most patients with GERD can be successfully managed by lifestyle modifications and
Drug therapy for GERD is focused on improving LES function, increasing esophageal
clearance, decreasing volume and acidity of reflux, and protecting the esophageal
Because of the link between GERD and Barrett’s esophagus, patients are instructed to see
their health care provider if symptoms persist.
The two most common types of hiatal hernia are sliding and paraesophageal (rolling).
Factors that predispose to hiatal hernia development include increased intraabdominal
pressure, including obesity, pregnancy, ascites, tumors, tight girdles, intense physical
exertion, and heavy lifting on a continual basis. Other factors are increased age, trauma,
poor nutrition, and a forced recumbent position (e.g., prolonged bed rest).
Two important risk factors for esophageal cancer are smoking and excessive alcohol
Gastritis occurs as the result of a breakdown in the normal gastric mucosal barrier.
Drugs such as aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), digitalis, and
alendronate (Fosamax) have direct irritating effects on the gastric mucosa. Dietary
indiscretions can also result in acute gastritis.
The symptoms of acute gastritis include anorexia, nausea and vomiting, epigastric
tenderness, and a feeling of fullness. Peptic Ulcer Disease