Gastroesophageal reflux disease (GERD) is one of the most common functional disorders of the upper digestive system, which causes symptoms such as heartburn, acid reflux, chest pain, and sometimes extraesophageal symptoms such as chronic cough and hoarseness.

The prevalence of this disease has increased in recent decades due to lifestyle changes, obesity, high-fat diets and high consumption of processed foods, and today it is considered as one of the common reasons for patients to refer to gastroenterologists. Normally, the lower esophageal sphincter (LES) prevents the reflux of stomach contents by creating enough pressure. In GERD patients, this sphincter is either weakened or has transient laxity (TLESR), which leads to the leakage of stomach acid into the esophagus. Delayed gastric emptying, hiatal hernia, and esophageal motility disorders are other aggravating factors of this disease. Clinical

Classic symptoms:

Heartburn

Regurgitation

Pain or discomfort in the epigastric and chest area

Non-classical symptoms (Extra-esophageal):

Chronic dry cough

Hoarseness or voice change

Feeling of food stuck in the throat (Globulus)

Treatment-resistant asthma

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🧪 Diagnosis

GERD diagnosis is often based on clinical history, but in refractory cases or alarm symptoms, additional investigation is required:

Diagnostic tests:

1. Upper endoscopy (EGD): examination of inflammation, ulcer, stricture or Barrett's esophagus

2. Esophageal manometry: investigation of pressure and movement function of esophagus and lower sphincter

3. 24-hour esophageal PH-metry: the gold standard to confirm the pathological contact of acid with the esophagus

4. Impedance measurement: to investigate non-acidic reflux (in patients not responding to PPIs) Drug: Proton pump inhibitors (PPI): such as omeprazole, pantoprazole, dexlansoprazole Dose: once in the morning fasting - twice a day if needed and temporary

Non-pharmacological interventions:

Weight reduction in obese patients

Avoid heavy, late and fatty meals

Elevate the head of the bed when sleeping

Avoid alcohol, coffee, chocolate, mint and Smoking

Surgical interventions:

In patients resistant to treatment or with Barrett's esophagus or those who do not want to take long-term medication:

Nissen fundoplication

New technologies such as LINX or Stretta

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⚠️ Potential complications

High-grade esophagitis

Esophageal stricture

Barrett's esophagus (premalignant)

Esophageal adenocarcinoma

📌 Conclusion

GERD is a chronic, recurring disease with a wide range of clinical manifestations that requires a comprehensive clinical and diagnostic approach. Early diagnosis, patient education, lifestyle modification and appropriate drug prescription can prevent serious complications such as Barrett's esophagus and esophageal cancer.