About gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common gastric diseases and occurs when the stomach contents reflux (flow backwards) into the esophagus. Reflux  of this kind leads to troublesome symptoms, pain and discomfort and/or additional complications.[1],[2] For those who experience persistent, recurring symptoms, GERD can disrupt their everyday physical, social and emotional wellbeing, in spite of efforts to manage their condition.[3]

Symptoms of GERD

The main symptoms of GERD are a burning sensation behind the breastbone (commonly referred to as heartburn). The pain and discomfort caused by heartburn and other symptoms of GERD can have a considerable effect on daily life and may interfere with:

• Manual work, housework, gardening and sport (because symptoms are often worse during physical exertion)[3]
• Social occasions, (such as eating with family and friends) because symptoms are often worse during and after meals.[3] Up to two-thirds of sufferers report that GERD substantially influences their eating habits[4]
• Sleep (because symptoms are often worse when lying down.[3] Up to 80% of patients have trouble sleeping, because symptoms disturb sleep and cause tiredness the following day[5]
• Sexual activity[3]

Global Montreal Definition

The Global Montreal Definition of GERD[1] reflects and summarizes the best currently available research in this area, and defines the characteristic symptoms and complications related to GERD. Importantly, it puts the patient in focus and states that the GERD diagnosis can be made on symptoms only. This is particularly important to primary care and it avoids costly referrals and investigations.

The Global Definition of GERD was developed by a working group of 44 internationally renowned experts from 18 countries, both specialists in GI disease and primary care physicians. Consensus was achieved in all aspects of GERD. The World Organization of Gastroenterology (OMGE) has given its full endorsement of the Global Definition.

Diagnosing GERD

According to the Global Montreal Definition of GERD, GERD syndrome can be diagnosed on the basis of persistent symptoms that affect quality of life in the patient’s own opinion. In general, mild symptoms two or more times a week as well as acid regurgitation, or moderate/severe symptoms once a week are associated with a significant impact on the quality of life.[6]

Diagnosis can also be assisted by GERD-Q, a new assessment tool developed for healthcare professionals to identify GERD and the impact level among patients with upper GI symptoms, as well as measuring treatment response.

GERD Q Physicians.pdf

The term GERD incorporates a spectrum of disease severity, patient types and attitudes towards the disease. Recent research has indicated that patients can be defined based on the physical and psychological impact of the disease.[7]

1. Patients with ‘inconveniencing GERD’: The condition has a low physical and psychological impact. The typical patient experiences non continuous symptoms, perceived to be mostly lifestyle related
2. Patients with ‘recurrent, distressing GERD’: The condition has a physical and psychological impact. The typical patient suffers symptoms that keep coming back, causing the patient worry and anxiety
3. Patients with ‘long term, disrupting GERD’: The condition has a high physical and psychological impact. The typical patient will have suffered from GERD for a long time with symptoms that disrupt their everyday life. This patient can be at high risk of complications, such as reflux esophagitis which they may have already experienced

Diagnosing GERD in children

In children, GERD is primarily diagnosed by the symptoms displayed, supplemented by selected diagnostic investigations (e.g. an endoscopy, esophageal pH-monitoring).[8] A global evidence-based consensus group has recently concluded that the Global Montreal Definition of GERD can be applied to children stating that: ‘GERD in pediatric patients is present when reflux of gastric contents is the cause of troublesome symptoms and/or complications.

GERD Treatment

Like all progressive medical conditions, if the symptoms of GERD continue untreated, then there are greater chances of complications including stricture of the esophagus, ulceration, bleeding and Barrett’s esophagus (the lining of esophagus is replaced by a type of tissue similar to that normally found in the intestine) which may be associated with cancer.[2]

The recommended treatment for GERD is proton pump inhibitor (PPI) therapy.[9] PPIs work by inhibiting the acid pumps of the cells lining the stomach wall, thus preventing the secretion of stomach acid. Most patients with GERD require long-term management; international guidelines recommend a ‘step down’ from the initial healing dose of PPI in order to maintain freedom from symptoms and esophagitis.[9]

Nexium is a widely known PPI that provides consistent and effective relief from the disruption of GERD.

References

1. Vakil N, Van Zanten SV, Kahrilas P, Dent J, Jones R and the Global Consensus Group. The Montreal Definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900–20.
2. Malfertheiner P, Hallerbäck B. Clinical manifestations and complications of gastroesophageal reflux disease (GERD). Int J Clin Pract 2005;59:346–55.
3. Liker H, Hungin P, Wiklund I. Managing gastroesophageal reflux disease in primary care: the patient perspective. J Am Board Fam Pract 2005;18:393–400.
4. The Burning Question Survey was executed by Martin Hamblin GfK 2002. Data was collected from France, Germany, Japan, UK and USA
5. Shaker R, Castell DO, Schoenfeld PS, Spechler SJ. Nighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Association. Am J Gastroenterol. 2003 Jul;98(7):1487-93.
6. Dent J, Brun J, Fendrick A, Fennerty M, Janssens J, Kahrilas P et al. on behalf of the Genval Workshop Group. An evidence-based appraisal of reflux disease management – the Genval Workshop Report. Gut 1999; Suppl 2:S1–15
7. King A, Macdonald C, Örn C. Understanding gastroesophageal reflux disease (GERD): a patient-segmentation analysis. Scandinavian Journal of Gastroenterology Supplement 2007;42(Suppl 244):21, Abs P6
8. Pediatric/Adolescent Gastroesophageal Reflux Association (PAGER) (1998c). Pediatric gastroesophageal reflux (GER) [on-line]. Available:http://www.reflux.org/reflux/paghomfa.nsf/pages/gerpediatric.htm
9. Dent J, Brun J, Fendrick A, Fennerty M, Janssens J, Kahrilas P et al. on behalf of the Genval Workshop Group. An evidence-based appraisal of reflux disease management – the Genval Workshop Report. Gut 1999; Suppl 2:S1–15