The term reflux is defined as a return or backward flow. Gastroesophageal reflux is backward flow of stomach contents into the esophagus.

Gastroesophageal reflux disease (GERD) usually indicates functional incompetence of the lower esophageal sphincter. Factors that contribute to the competence of the gastroesophageal junction include pressure at the intrinsic sphincter, the position of the cardioesophageal junction, the action of the diaphragm, and gravity when the patient is in an upright position.

The most prominent symptom is heartburn, with or without regurgitation of gastric contents into the mouth. Complications of GERD include esophagitis, esophageal stricture (see Diagnostic Code: 7203 Esophagus, stricture of), esophageal ulcer, and Barrett's metaplasia.

A detailed history usually gives strong indications for a diagnosis. X-rays, esophagoscopy, esophageal manometry, pH monitoring, the Bernstein acid perfusion test, and esophageal biopsy help to confirm the diagnosis and reveal possible complications. X-rays after the swallowing of barium usually show esophageal ulcers and peptic strictures. The use of esophagoscopy usually gives an accurate diagnosis of esophagitis with or without hemorrhage.

Management includes elevating the head while lying, and avoiding substances that stimulate acid secretion (e.g., coffee, alcohol). In addition, avoiding certain drugs (e.g., anticholinergics), specific foods (fats, chocolate), and smoking are suggested since they all lower esophageal sphincter competence. Medications that may improve the condition include antacids after meals and at bedtime, H2 blockers to reduce gastric acidity (sometimes with other drugs); and use of cholinergic agonists.

Patients with serious reflux disease are placed on medications and surgery may be indicated. Esophagitis may cause hemorrhage. However, surgery is not indicated if the hemorrhage is not massive; but the condition may recur. Esophageal strictures are managed by continuous, intense medical regimens and repeated dilation to maintain patency. If proper dilation is maintained, patients are not restricted in the foods they eat. Patients may require endoscopic examinations every one to two years to evaluate for possible transformation to malignancy.

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