{"id":1723,"date":"2025-12-03T04:00:00","date_gmt":"2025-12-03T00:00:00","guid":{"rendered":"http:\/\/vitamed.test\/gastroesophageal-reflux-disease-gerd\/"},"modified":"2026-09-14T14:41:15","modified_gmt":"2026-09-14T10:41:15","slug":"gastroesophageal-reflux-disease-gerd","status":"publish","type":"post","link":"https:\/\/vitamed.production.am\/en\/gastroesophageal-reflux-disease-gerd\/","title":{"rendered":"GASTROESOPHAGEAL REFLUX DISEASE (GERD)"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">What is Gastroesophageal Reflux<\/h2>\n\n\n\n<p><strong>Gastroesophageal Reflux Disease (GERD)<\/strong>&nbsp;is a chronic relapsing disease caused by the pathological reflux of gastric contents (acid, pepsin, bile) into the esophagus, leading to characteristic symptoms (heartburn, regurgitation) and\/or the development of esophagitis and other complications.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Causes and Risk Factors<\/h2>\n\n\n\n<p>The pathophysiology of GERD includes:<\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Decreased lower esophageal sphincter (LES) tone \u2014 the main mechanism<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Esophageal motility disorders (delayed acid clearance)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Delayed gastric emptying<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Increased intra-abdominal pressure<\/p>\n\n\n\n<p>Clinically significant risk factors:<\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Obesity, especially abdominal (increases intra-abdominal pressure)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Pregnancy \u2014 hormonal (progesterone) and mechanical changes<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Smoking \u2014 reduces LES tone<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Alcohol, chocolate, coffee, fatty and spicy foods<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Certain medications: calcium channel blockers, nitrates, anticholinergic agents<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Hiatal hernia<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Main Symptoms<\/h2>\n\n\n\n<p>Symptoms are divided into:<\/p>\n\n\n\n<p>Typical (esophageal):<\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Heartburn (burning sensation behind the sternum, often worsened by lying down or after eating)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Acid regurgitation (return of acidic contents into the mouth)<\/p>\n\n\n\n<p>Atypical (extraesophageal):<\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Chest pain not related to the heart<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Chronic cough<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Hoarseness, especially in the morning<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Postnasal drip, a feeling of a &#8220;lump&#8221; in the throat<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Dysphagia (difficulty swallowing)<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-9-16 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" class=\"vitamed-youtube-short\" title=\"28 May 2026\" width=\"422\" height=\"750\" src=\"https:\/\/www.youtube.com\/embed\/pzGe4IYY81g?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Diagnostics<\/h2>\n\n\n\n<p>1. Clinical assessment (for typical symptoms):<\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Patients with classic symptoms can be prescribed empirical PPI therapy without further diagnostics.<\/p>\n\n\n\n<p>2. Instrumental methods:<\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Fibrogastroscopy (EGD) \u2014 recommended for:<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Alarm symptoms (dysphagia, anemia, weight loss, bleeding)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Lack of effect from PPIs<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Age &gt;50 years with new symptoms<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Suspicion of complications (erosive esophagitis, Barrett&#8217;s esophagus)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;24-hour esophageal pH-impedance monitoring \u2014 the &#8220;gold standard&#8221; for confirming reflux in case of a doubtful diagnosis or normal endoscopy<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Esophageal manometry \u2014 to rule out motor disorders (especially before surgical treatment)<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Modern methods of treatment<\/h2>\n\n\n\n<p><strong>1. Non-drug measures (recommended for all patients):<\/strong><\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Weight control<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Elevation of the head of the bed (by 15\u201320 cm)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Avoiding eating 2\u20133 hours before bedtime<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Excluding trigger foods: chocolate, coffee, mint, fatty foods, alcohol<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Smoking cessation<\/p>\n\n\n\n<p><strong>2. Drug treatment:<\/strong><\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Proton pump inhibitors (PPIs) \u2014 first-line therapy<\/p>\n\n\n\n<p><strong>3. Surgical treatment:<\/strong><\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Nissen fundoplication (laparoscopic)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Indications: ineffectiveness of medications, refusal of long-term therapy, presence of complications<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Magnetic sphincter implant (LINX)<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Complications and prevention<\/h2>\n\n\n\n<p>Complications of GERD:<\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Erosive esophagitis (according to the Los Angeles classification A\u2013D)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Esophageal strictures<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Barrett&#8217;s esophagus \u2014 epithelial metaplasia, associated with esophageal adenocarcinoma<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Aspiration pneumonitis, bronchial asthma<\/p>\n\n\n\n<p>Prevention:<\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Maintenance PPI therapy<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Eradication of risk factors<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Screening for Barrett&#8217;s esophagus in men &gt;50 years with long-term GERD and risk factors<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">GERD and pregnancy<\/h3>\n\n\n\n<p>The frequency of reflux in pregnancy is up to 50\u201380% of women, especially in the II\u2013III trimesters.<\/p>\n\n\n\n<p><strong>Mechanisms:<\/strong><\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Increased progesterone levels \u2192 decreased LES tone<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Increased intra-abdominal pressure<\/p>\n\n\n\n<p><strong>When to see a doctor<\/strong><\/p>\n\n\n\n<p>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Heartburn \u22652 times a week, especially if antacids are ineffective<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Chest pain not related to food intake<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Difficulty swallowing (dysphagia)<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Weight loss, anemia<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Relapses after discontinuation of PPI therapy<br>&nbsp;&nbsp; &nbsp;\u2022&nbsp;&nbsp; &nbsp;Atypical symptoms (hoarseness, cough, asthma)<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Gastroesophageal Reflux Disease (GERD) is a chronic relapsing disease caused by the pathological reflux of gastric contents (acid, pepsin, bile) into the esophagus, leading to characteristic symptoms (heartburn, regurgitation) and\/or the development of esophagitis and other complications.<\/p>\n","protected":false},"author":1,"featured_media":1718,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[173,171],"tags":[],"class_list":["post-1723","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog-en","category-blog"],"acf":[],"_links":{"self":[{"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/posts\/1723","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/comments?post=1723"}],"version-history":[{"count":3,"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/posts\/1723\/revisions"}],"predecessor-version":[{"id":6096,"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/posts\/1723\/revisions\/6096"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/media\/1718"}],"wp:attachment":[{"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/media?parent=1723"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/categories?post=1723"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vitamed.production.am\/en\/wp-json\/wp\/v2\/tags?post=1723"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}