HISTORY. Elicit a history of contributing factors, including the regular consumption of fatty foods, caffeinated beverages, chocolate, nicotine, alcohol, or peppermint. Take a drug history to determine if the patient has been taking drugs that may contribute to GERD: beta-adrenergic blockers, calcium channel blockers, nitrates, theophylline, diazepam, anticholinergic drugs, estrogen, and progesterone.

Little relationship appears to occur between the severity of symptoms and the degree of esophagitis. Some patients have minimal evidence of esophagitis, whereas others with severe, chronic inflammation may have no symptoms until stricture occurs. Patients may describe the characteristic symptom of heartburn (also known as pyrosis or dyspepsia). The discomfort is often a sub-or retrosternal pain that radiates upward to the neck, jaw, or back. Patients describe a worsening pain when they bend over, strain, or lie flat. With severe inflammation, discomfort occurs after each meal and lasts for up to 2 hours. Patients may describe coughing, hoarseness, or wheezing at night.

Patients may also report regurgitation, with a sensation of warm fluid traveling upward to the throat and leaving a bitter, sour taste in the mouth. Other symptoms may include difficulty swallowing (dysphagia) and painful swallowing (odynophagia) during eating, as well as eructation, flatulence, or bloating after eating.

PHYSICAL EXAMINATION. Generally, the patient's physical appearance is unchanged by GERD. On rare occasions, some patients may experience unexplained weight loss.

PSYCHOSOCIAL. Psychosocial assessment should include assessment of the degree of stress the person experiences and the strategies she or he uses to cope with stress.

Diagnostic Highlights


Normal Result

Abnormality with Condition


Esophageal pH monitoring

Congruent esophageal pressures bilaterally; competent lower esophageal sphincter (LES)

Abnormal contractions and peristalsis; incompetent LES; low resting pressure of LES

Presence of gastric contents in the esophagus decreases pH

Multilumen esophageal catheter introduced through mouth. Used to measure esophageal pressures during a variety of swallowing maneuvers

Other Tests: Esophagogastroduodenoscopy (EGD), scintigraphy, barium esopha-gogram, Bernstein's test (acidic solution infused into stomach causing heartburn in patients with GERD)

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