Gastroesophageal Reflux (GERD) occurs when stomach acid backs up into the esophagus. During normal eating, the lower esophageal sphincter (LES) contracts to prevent stomach acid and contents from refluxing back. When this is weakened or not closing properly, reflux of stomach acid can cause symptoms of heartburn or laryngopharyngeal reflux (LPR). The symptoms of GERD also include acid regurgitation, nausea, hoarseness (especially in the morning), or trouble swallowing.
Laryngopharyngeal reflux (LPR) occurs when stomach acid refluxes all the way up past the upper esophageal sphincter (UES) and into the back of the throat and possibly all the way to the back of the nose. Patients with LPR will often report a bitter taste in the back of the throat (especially in the morning), hoarseness, a sensation of burning or something stuck in the throat, and occasionally cough and difficulty breathing. Symptoms of LPR can occur without the significant acid reflux that causes heartburn.
People of all ages from infants to adults can get GERD. Often the symptoms are triggered by lifestyle factors or from physical causes such as a malfunctioning LES, hiatal hernia, abnormal esophageal contractions, and slow stomach emptying. Lifestyle factors such as diet, stress, overeating, and even pregnancy can contribute. Most infants outgrow their GERD or LPR by the end of their first year, however, problems such as feeding difficulty, cough, asthma, sleep disordered breathing, aspiration, or hoarseness can persist longer.
In adults, GERD can be diagnosed by physical examination, tests, or by a trial of treatment with medication. The physical exam may include an endoscopic examination of the throat and esophagus. Tests may include biopsy, x-rays, 24 hour pH probe, esophageal motility testing (manometry), emptying studies of the stomach, and esophageal acid perfusion (Bernstein test). Severe GERD refractory to medical management or resulting from anatomical abnormalities may require surgery such as fundoplication, a procedure where a part of the stomach is wrapped around the lower esophagus to tighten the LES. Primary care physicians, otolaryngologists, gastroenterologists, and general surgeons work together to diagnose and manage patients with these symptoms.
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