Gastroesophageal reflux disease, or GERD refers to the condition of symptoms and findings caused by the retrograde flow of gastric contents into the esophagus. The hallmark symptom of GERD is heartburn, or burning substernal chest pain that radiates upward. Up to 10% of Americans suffer from heartburn on a daily basis, and over a third suffer from heartburn at least once a month.

Many patients with GERD experience their worst symptoms soon after meals or when they lay down. GERD may be distinguished from laryngopharyngeal reflux, or LPR. LPR is caused by the regurgitation of stomach contents all the way up through the esophagus and into the throat. Most patients with LPR do not suffer from heartburn, the hallmark of GERD. In comparison to patients with GERD who usually reflux in the evening when supine, patients with LPR are typically daytime, upright refluxers. Please refer to the section on LPR for a more detailed description.

Reflux, either GERD or LPR may often be difficult to diagnose. In fact, it is sometimes referred to as the great masquerader because its symptoms may be confused for a different disorder, such as asthma, cardiac disease, or infection. Up to a third of all cardiac catheterizations performed to evaluate chest pain are normal. As many as half of these normal catheterizations will have identifiable esophageal abnormalities, many associated with reflux. The reflux symptom index (RSI) is a 9-item self-administered survey that evaluates the severity of reflux. During psychometric testing, it displayed excellent reliability and crtieria-based validity. Normative data suggests that a RSI of greater than or equal to10 is clinically significant. Although the survey instrument is designed to be used by a physician in conjunction with other pertinent patient history and physical examination findings, an abnormal RSI (> 10) may be indicative of significant reflux. Please feel free to take and score your own RSI.

Up to 10% of persons with GERD will develop complitations such as esophagitis or esophageal stricture. The endoscopic image and the esophagram below are that of an individual with a severe reflux induced esophageal stricture.

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	Esophageal stricture (arrows) in a 53 year-old individual with severe gastroesophageal reflux.

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Antireflux medications controlled the reflux and surgical dilation opened up the stricture. The post-treatment images below reveal the now patent mid-portion of the esophagus.

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Several different therapeutic strategies exist for the treatment of GERD. Please refer to the section on Reflux Therapy for a detailed description of reflux treatment.

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