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Encyclopedia > Gastroesophageal reflux disease
Gastroesophageal reflux disease
Classification & external resources
ICD-10 K21.
ICD-9 530.81
OMIM 109350
DiseasesDB 23596
eMedicine med/857  ped/1177 radio/300
MeSH D005764

Gastroesophageal Reflux Disease (GERD or GORD using the British œsophageal) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus[1]. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... The mucous membranes (or mucosa) are linings of ectodermic origin, covered in epithelium, that line various body cavities and internal organs. ... The esophagus (also spelled oesophagus/Å“sophagus, Greek ), or gullet is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. ...


This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter (LES), transient LES relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ... It has been suggested that this article or section be merged with Cardia. ... Hiatus hernia or hiatal hernia is the protrusion (or hernia) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. ...

Contents

Symptoms

Adults

Heartburn is the major symptom of acid in the esophagus, characterized by burning discomfort behind the breastbone (sternum). Findings in GERD include esophagitis (reflux esophagitis) — inflammatory changes in the esophageal lining (mucosa) —, strictures, difficulty swallowing (dysphagia), and chronic chest pain. Patients may have only one of those findings. Typical GERD symptoms include cough, hoarseness, voice changes, chronic ear ache, burning chest pains, nausea or sinusitis. GERD complications include stricture formation, Barrett's esophagus, esophageal spasms, esophageal ulcers, and possibly even lead to esophageal cancer, especially in adults over 60 years old. The sternum (from Greek στέρνον, sternon, chest) or breastbone is a long, flat bone located in the center of the thorax (chest). ... Esophagitis (or Oesophagitis) is inflammation of the esophagus. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... Dysphagia () is a medical term defined as difficulty swallowing. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... Sinusitis is an inflammation of the paranasal sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or autoimmune issues. ... Barretts esophagus (sometimes called Barretts syndrome, CELLO, columnar epithelium lined lower (o)esophagus or colloquially as Barretts) refers to an abnormal change (metaplasia) in the cells of the lower end of the esophagus thought to be caused by damage from chronic acid exposure, or reflux esophagitis. ... Esophageal cancer is malignancy of the esophagus. ...


Occasional heartburn is common but does not necessarily mean one has GERD. Patients with heartburn symptoms more than once a week are at risk of developing GERD. A hiatal hernia is usually asymptomatic, but the presence of a hiatal hernia is a risk factor for developing GERD. Hiatus hernia or hiatal hernia is the protrusion (or hernia) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. ... In medicine, a disease is asymptomatic when it is at a stage where the patient does not experience symptoms. ...


Children

GERD may be difficult to detect in infants and children. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems. Inconsolable crying, failure to gain adequate weight, refusing food, bad breath, and belching or burping are also common. Children may have one symptom or many — no single symptom is universal in all children with GERD. “Baby” redirects here. ... For other uses, see Child (disambiguation). ... Emesis redirects here. ... The process of burping, also known as a belching or eructation, is an often audible release through the mouth of gas that has accumulated in the stomach or esophagus. ... Burping, also known as belching, ructus, or eructation is the release of gas from the digestive tract (mainly esophagus and stomach) through the mouth. ...


It is estimated that of the approximately 4 million babies born in the U.S. each year, up to 35% of them may have difficulties with reflux in the first few months of their life. Most of those children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition.


Babies' immature digestive systems are usually the cause, and most infants stop having acid reflux by the time they reach their first birthday. Some children do not outgrow acid reflux, however, and continue to have it into their teen years. Children that have had heartburn that does not seem to go away, or any other GERD symptoms for a while, should talk to their parents and visit their doctor.


Diagnosis

Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach. This is a complication of chronic gastroesophageal reflux disease, and can be a cause of dysphagia or difficulty swallowing
Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach. This is a complication of chronic gastroesophageal reflux disease, and can be a cause of dysphagia or difficulty swallowing

A detailed history taking is vital to the diagnosis. Useful investigations may include barium swallow X-rays, esophageal manometry, 24 hour esophageal pH monitoring and Esophagogastroduodenoscopy (EGD). In general, an EGD is done when the patient does not respond well to treatment, or has alarm symptoms including: dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes. Some physicians advocate once-in-a-lifetime endoscopy for patients with longstanding GERD, to evaluate the possible presence of Barrett's esophagus, a precursor lesion for esophageal adenocarcinoma. Image File history File links Peptic_stricture. ... Image File history File links Peptic_stricture. ... In medicine (gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract. ... The esophagus (also spelled oesophagus/Å“sophagus, Greek ), or gullet is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. ... In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ... Dysphagia () is a medical term defined as difficulty swallowing. ... For other uses, see Barium (disambiguation). ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... For other uses, see PH (disambiguation). ... Endoscopic still of esophageal ulcers seen after banding of esophageal varices, at time of esophagogastroduodenosocopy In medicine (gastroenterology), esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract up to the duodenum. ... For other uses, see Asthma (disambiguation). ... Barretts esophagus (sometimes called Barretts syndrome, CELLO, columnar epithelium lined lower (o)esophagus or colloquially as Barretts) refers to an abnormal change (metaplasia) in the cells of the lower end of the esophagus thought to be caused by damage from chronic acid exposure, or reflux esophagitis. ... Esophageal cancer is malignancy of the esophagus. ...


Esophagogastroduodenoscopy (EGD) (a form of endoscopy) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surfaces of the esophagus, stomach, and duodenum. Endoscopic still of esophageal ulcers seen after banding of esophageal varices, at time of esophagogastroduodenosocopy In medicine (gastroenterology), esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract up to the duodenum. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube connecting the stomach to the jejunum. ...


Biopsies can be performed during gastroscopy and these may show: Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ...

  • Edema and basal hyperplasia (non-specific inflammatory changes)
  • Lymphocytic inflammation (non-specific)
  • Neutrophilic inflammation (usually due to reflux or Helicobacter gastritis)
  • Eosinophilic inflammation (usually due to reflux)
  • Goblet cell intestinal metaplasia or Barretts esophagus.
  • Elongation of the papillae
  • Thinning of the squamous cell layer
  • Dysplasia or pre-cancer.
  • Carcinoma.

Helicobacter pylori is a bacterium that infects the mucus lining of the human stomach. ... Gastritis is inflammation of the gastric mucosa. ... Dysplasia (from Greek, roughly: bad form) is a term used in pathology to refer to an abnormality in maturation of cells within a tissue. ... In medicine, carcinoma is any cancer that arises from epithelial cells. ...

Pathophysiology

GERD is caused by a failure of the Anti-Reflux Barrier (ARB) and its primary component, the GastroEsophageal valve (GEV). The understanding of the GEV has continued to progress in recent years, and more focus is currently being placed on the GEV, rather than the Lower Esophageal Sphincter (LES), as the largest contributor to the ARB. Researchers have shown the GEV's robust nature and have shown that the intact GEV alone is highly competent to stop reflux. For example, in cadavers, where no muscle tone or LES pressure is present, the stomach ruptures when filled with water before reflux can occur. This shows the GEV's power to stop reflux even in the absence of any LES pressure.


In healthy patients, the "Angle of His," the angle at which the esophagus enters the stomach, is intact creating a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where it can cause burning and inflammation of sensitive esophageal tissue.


Another paradoxical cause of GERD-like symptoms is not enough stomach acid (hypochlorhydria). The valve that empties the stomach into the intestines is triggered by acidity. If there is not enough acid, this valve does not open and the stomach contents are churned up into the esophagus. However, there is still enough acidity to irritate the esophagus. Achlorhydria or hypochlorhydria is decreased production of gastric acid by the stomach. ...


Factors that can contribute to GERD are:

GERD has been linked to laryngitis, chronic cough, pulmonary fibrosis, earache, and asthma, even when not clinically apparent, as well as to laryngopharyngeal reflux and ulcers of the vocal cords. There appears to be an association with obstructive sleep apnea, although its conjectural relationship with GERD remains unproven.[4] and PMID 17198758. A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. ... A graph of body mass index is shown above. ... Zollinger-Ellison syndrome is a disorder where increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid. ... In humans, gastrin is a hormone that stimulates secretion of gastric acid by the stomach. ... Hypercalcaemia is an elevated calcium level in the blood. ... In humans, gastrin is a hormone that stimulates secretion of gastric acid by the stomach. ... Scleroderma is a rare, chronic disease characterized by excessive deposits of collagen in the skin or other organs. ... Laryngitis is an inflammation of the larynx. ... Diffuse parenchymal lung disease (DPLD), also known as interstitial lung disease, refers to a group of lung diseases, affecting the alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues. ... Otalgia is ear pain or an earache. ... Laryngoscopic view of the vocal folds. ... Sleep apnea, sleep apnoea or sleep apnœa is a sleep disorder characterized by pauses in breathing during sleep. ...


Treatment

The rubric "lifestyle modifications" is the term physicians use when recommending non-drug GERD treatments. A 2006 review suggested that evidence for most dietary interventions is anecdotal; only weight loss and elevating the head of the bed were supported by evidence[5]. A subsequent randomized crossover study showed benefit by avoiding eating two hours before bed.[2] Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ... A crossover trial is one where patients are given all of the medications to be studied in random order. ...


Foods

Certain foods and lifestyle are considered to promote gastroesophageal reflux:

  • Coffee, alcohol, and excessive amounts of Vitamin C supplements stimulate gastric acid secretion. Taking these before bedtime especially can cause evening reflux. (Although a study published in 2006 by Stanford University researchers disputes the effect of coffee, acidic, spicy foods etc. as a myth.[5])
  • Antacids based on calcium carbonate (but not aluminum hydroxide) were found to actually increase the acidity of the stomach. However, all antacids reduced acidity in the lower esophagus, so the net effect on GERD symptoms may still be positive.[6].
  • Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these tends to help. Fat also delays stomach emptying.
  • Eating shortly before bedtime (For clinical purposes, this usually means 2-3 hours before going to bed).
  • Large meals. Having more but smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.
  • Soda or pop (regular or diet).
  • Chocolate and peppermint.
  • Acidic foods, such as oranges and tomatoes
  • Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
  • Milk and milk-based products contain calcium and fat, and should be avoided before bedtime.

For other uses, see Coffee (disambiguation). ... Alcoholic beverages An alcoholic beverage (also known as booze in slang term) is a drink containing ethanol, commonly known as alcohol, although in chemistry the definition of alcohol includes many other compounds. ... This article is about the nutrient. ... Stanford redirects here. ... An antacid is any substance that counteracts stomach acidity. ... Calcium carbonate is a chemical compound, with the chemical formula CaCO3. ... ... The cigarette is the most common method of smoking tobacco. ... For other uses, see Chocolate (disambiguation). ... Binomial name Mentha × piperita L. Peppermint (Mentha × piperita) is a (usually) sterile hybrid mint, a cross between watermint (Mentha aquatica) and spearmint (Mentha spicata). ... For other uses, see Acid (disambiguation). ... Cabbage plants Edible plants in the family Brassicaceae (also called Cruciferae) are termed Cruciferous vegetables. ... Cultivar Group Brassica oleracea Gemmifera Group The Brussels sprout (Brassica oleracea Gemmifera Group) is a cultivar group of cabbage cultivated for its small (typically 2. ... A glass of cows milk. ...

Positional therapy

Sleeping on one's left side has been shown to drastically reduce nighttime reflux episodes in patients.[7].


Elevating the head of the bed is also effective. When combining drug therapy, food avoidance before bedtime, and elevation of the head of the bed, over 95% of patients will have complete relief[citation needed]. Additional conservative measures may be considered if there is incomplete relief. Another approach is to apply all conservative measures for maximum response. A meta-analysis suggested that elevating the head of bed is an effective therapy, although this conclusion was only supported by nonrandomized studies [5]. A meta-analysis is a statistical practice of combining the results of a number of studies. ...


Elevating the head of the bed can be done by using various items: plastic or wooden bed risers that support bed posts or legs, a bed wedge pillow, or a wedge or an inflatable mattress lifter that fits in between mattress and box spring. The height of the elevation is critical and must be at least 6 to 8 inches (15 to 20 cm) in order to be at least minimally effective to prevent the backflow of gastric fluids. It should be noted that some innerspring mattresses do not work well when inclined and tend to cause back pain, thus foam based mattresses are to be preferred. Moreover, some use higher degrees of incline than provided by the commonly suggested 6 to 8 inches (15 to 20 cm) and claim greater success.


Drug treatment

A number of drugs are registered for GERD treatment, and they are among the most-often-prescribed forms of medication in most Western countries. They can be used in combination with other drugs, although some antacids can interfere with the function of other drugs: This article does not cite any references or sources. ...

Proton pump inhibitors (or PPIs) are a group of drugs whose main action is pronounced and long-lasting reduction of gastric acid production. ... A bottle of antacid tablets An antacid is any substance, generally a base, which counteracts stomach acidity. ... For other uses, see PH (disambiguation). ... Alginic acid (algine, alginate) is a viscous gum that is abundant in the cell walls of brown algae. ... It has been suggested that Alginin be merged into this article or section. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... Alginic acid (algine, alginate) is a viscous gum that is abundant in the cell walls of brown algae. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... An H2-receptor antagonist, often shortened to H2-antagonist, is a drug used to block the action of histamine on parietal cells in the stomach, decreasing acid production by these cells. ... Ranitidine (INN) (IPA: ) is a histamine H2-receptor antagonist that inhibits stomach acid production, and commonly used in the treatment of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). ... Famotidine is a histamine H2-receptor antagonist that inhibits stomach acid production, and is commonly used in the treatment of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). ... An H1 antihistamine is a histamine antagonist which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the H1 receptor. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... This article or section does not adequately cite its references or sources. ... Cisapride is a parasympathomimetic which acts as a serotonin 5-HT4 agonist. ... The long QT syndrome (LQTS) is a heart disease in which there is an abnormally long delay between the electrical excitation (or depolarization) and relaxation (repolarization) of the ventricles of the heart. ... Sucralfate is a prescription medication used to treat peptic ulcers. ...

Posture and GERD

In adults, a slouched posture is an important factor contributing to GERD. With a slouched posture there is no straight path between the stomach and esophagus; muscles around the esophagus go into a spasm. Gas and acidity get blocked in the spasm, causing coughing and other asthma-like symptoms. A meta-analysis suggested that elevating the head of the bed is an effective therapy, although this conclusion was only supported by nonrandomized studies.[5] A meta-analysis is a statistical practice of combining the results of a number of studies. ...


Surgical treatment

The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done laparoscopically.[9] This article does not cite any references or sources. ... Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. ...


An obsolete treatment is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication. A vagotomy is a surgical procedure that is performed only in humans. ... The vagus nerve (also called pneumogastric nerve or cranial nerve X) is the tenth of twelve paired cranial nerves, and is the only nerve that starts in the brainstem (within the medulla oblongata) and extends, through the jugular foramen, down below the head, to the abdomen. ...


Other treatments

In 2000 , the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. Another, the Stretta Procedure, uses electrodes to apply radio frequency energy to the LES. The long term outcomes of both procedures compared to a Nissen fundoplication are still being determined. “FDA” redirects here. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ... There are very few or no other articles that link to this one. ...


Subsequently the NDO Surgical Plicator was FDA cleared for the endoscopic GERD treatment. The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture-based implant. The Plicator is currently marketed by NDO Surgical, Inc. [1].


Another treatment that involved injection of a solution during endoscopy into the lower esophageal wall was available for about one year ending in late 2005. It was marketed under the name Enteryx. It was removed from the market due to several reports of complications from misplaced injections.


Barrett's esophagus

Barrett's esophagus, a type of dysplasia, is a precursor high-grade dysplasia, which is in turn a precursor condition for carcinoma. The risk of progression from Barrett's to dysplasia is uncertain but is estimated to include 0.1% to 0.5% of cases, and has probably been exaggerated in the past. Due to the risk of chronic heartburn progressing to Barrett's, EGD every 5 years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD. Barretts esophagus (sometimes called Barretts syndrome, CELLO, columnar epithelium lined lower (o)esophagus or colloquially as Barretts) refers to an abnormal change (metaplasia) in the cells of the lower end of the esophagus thought to be caused by damage from chronic acid exposure, or reflux esophagitis. ... Dysplasia (from Greek, roughly: bad form) is a term used in pathology to refer to an abnormality in maturation of cells within a tissue. ...


References

  1. ^ DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1999;94:1434-42. PMID 10364004.
  2. ^ a b Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". Am. J. Gastroenterol. 102 (10): 2128-2134. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791. 
  3. ^ Ayazi S, Crookes P, Peyre C, (2007). "Objective documentation of the link between gastroesophageal reflux disease and obesity". Am. J. Gastroenterol. 102 (S): 138-139. 
  4. ^ Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R (2004). "Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?". Clin. Gastroenterol. Hepatol. 2 (9): 761–8. PMID 15354276. 
  5. ^ a b c d Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569. 
  6. ^ Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S. Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn. Am J Ther 1995;2:546-552. PMID 11854825.
  7. ^ Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 1999;94:2069-73. PMID 10445529.
  8. ^ a b Tran T, Lowry A, El-Serag H (2007). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs". Aliment Pharmacol Ther 25 (2): 143-53. doi:10.1111/j.1365-2036.2006.03135.x. PMID 17229239. 
  9. ^ Abbas A, Deschamps C, Cassivi SD, et al. (2004). "The role of laparoscopic fundoplication in Barrett’s esophagus". Annals of Thoracic Surgery 77 (2): 393-396. PMID 14759403. 

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links


  Results from FactBites:
 
Gastroesophageal reflux disease (GERD, GORD, acid reflux) (916 words)
Gastroesophageal reflux disease (GERD, or GORD) is injury to the esophagus that develops from chronic exposure of the esophagus to acid coming up from the stomach (reflux).
Gastroesophageal reflux occurs when the lower esophageal sphincter is weak or relaxes allowing the stomach contents to flow up into the esophagus.
Gastroesophageal reflux disease in infants and children - Infants are more likely to have the lower esophageal sphincter (LES) relax when it should remain shut.
Gastroesophageal Reflux Disease (1097 words)
Gastroesophageal (GERD) reflux disease is the result of acid in the stomach splashing up into the esophagus, or swallowing tube.
Since reflux disease is a mechanical problem, it is clear that medical treatment will never cure the problem, but only relieve the symptoms.
There are several types of operations done to treat reflux disease, though all are similar in that they aim to repair the lower esophageal sphincter valve and thereby prevent reflux of acid into the esophagus.
  More results at FactBites »

 
 

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