- Passage of gastric content into the oesophagus due to relaxation of the lower oesophageal sphincter
- Acid or bile causes mucosal irritation
Aetiology
- Ineffective lower oesophageal sphincter
- Hiatus hernia
- Obesity
- Alcohol (increased acid secretion)
- Oesophageal dysmotility
- Pregnancy
- Drugs: nifedipine / isosorbide mononitrate
Clinical features
- Retrosternal burning pain (heartburn)
- Often during the night or when bending over
- Associated bitter taste in the mouth
- Sore throat / dysphonia
- Excessive salivation (water-brash)
- Nocturnal cough or bronchospasm (aspiration)
- Dysphagia (difficulty in swallowing)
- Peptic stricture
Investigations
- Trial of antacid / proton pump inhibitor
- Upper GI endoscopy
- Oesophageal pH studies and manometry
Management
- Lifestyle changes: reduce smoking / alcohol
- Lose weight
- Antacids
- Histamine2-receptor blocker, e.g. ranitidine
- Proton Pump inhibitors, e.g. omeprazole
- (Laparoscopic) Nissen fundoplication
Complications
- Peptic oesophageal strictures
- Barrett's oesophagus
- Oesophageal adenocarcinoma
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