Reflux and its relation to lung disease

GERD

Source: JAMA. 2020;324(24):2536-2547. doi:10.1001/jama.2020.21360

Definition: recurrent troublesome heartburn or regurgitation OR sequalae (e.g. Barrett's esophagus, esophagitis, stricture).

Not equal to gastritis (less severe, irritation) or dyspepsia (which happens occasionally in all individuals)

Pathophys: normally the LES relaxes when the stomach expands to facilitate passage. If this happens to much = reflux. Hiatal hernia can predispose to this by lessening the normal curve near the LES.

Risk factors: Weight (via increased freq HH, increased abd->thor pressure gradient, and other mechs), smoking, and genetics.

Treatment: PPI

• Give for 4-8 weeks (4 usually, 8 if esophagitis is present), then attempt to taper to lowest possible dose.
• if no response by 4-8 weeks, consider workup to confirm dx (pH, manometry, or endoscopy)
• if diagnosis confirmed, BID dosing will decrease time pH < 4, thus may be helpful.
• Don't consider surgery if they don't respond to PPI (won't work)

IF symptoms are primarily not classic heartburn, consider pH probe to establish diagnosis.

Ambulatory pH: establish if pH < 4 corresponds to symptoms. If not, may have functional heartburn (won't respond to PPi)