A Practical Guide to Reflux: Causes, Consequences and Care : Causes, Consequences and Care [1 ed.] 9781614701521, 9781613249222

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Copyright © 2011. Nova Science Publishers, Incorporated. All rights reserved. A Practical Guide to Reflux: Causes, Consequences and Care : Causes, Consequences and Care, Nova Science Publishers,

Copyright © 2011. Nova Science Publishers, Incorporated. All rights reserved. A Practical Guide to Reflux: Causes, Consequences and Care : Causes, Consequences and Care, Nova Science Publishers,

DIGESTIVE DISEASES - RESEARCH AND CLINICAL DEVELOPMENTS

A PRACTICAL GUIDE TO REFLUX

Copyright © 2011. Nova Science Publishers, Incorporated. All rights reserved.

CAUSES, CONSEQUENCES AND CARE

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A Practical Guide to Reflux: Causes, Consequences and Care : Causes, Consequences and Care, Nova Science Publishers,

DIGESTIVE DISEASES - RESEARCH AND CLINICAL DEVELOPMENTS

A PRACTICAL GUIDE TO REFLUX CAUSES, CONSEQUENCES AND CARE

Copyright © 2011. Nova Science Publishers, Incorporated. All rights reserved.

JOHN W. BIRK EDITOR

Nova Science Publishers, Inc. New York

A Practical Guide to Reflux: Causes, Consequences and Care : Causes, Consequences and Care, Nova Science Publishers,

Copyright © 2012 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com

NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works.

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Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Additional color graphics may be available in the e-book version of this book.

Library of Congress Cataloging-in-Publication Data A practical guide to reflux : causes, consequences, and care / editor, John W. Birk. p. ; cm. Includes bibliographical references and index. ISBN H%RRN) 1. Gastroesophageal reflux. I. Birk, John W. [DNLM: 1. Gastroesophageal Reflux. WI 250] RC815.7.P73 2011 616.3'24--dc23 2011020173

Published by Nova Science Publishers, Inc. † New York

A Practical Guide to Reflux: Causes, Consequences and Care : Causes, Consequences and Care, Nova Science Publishers,

Contents Preface

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Chapter 1

vii Gastroesophageal Reflux Disease: Incidence and Epidemiology Deepika Devuni 

1 

Chapter 2

Causes and Consequences of GERD Marcy Coash 

15 

Chapter 3

The Diagnosis of Gastroesophageal Reflux Disease Maria Johnson 

43 

Chapter 4

Treatment of GERD Priya Rangasamy 

59 

Index

A Practical Guide to Reflux: Causes, Consequences and Care : Causes, Consequences and Care, Nova Science Publishers,

81 

Copyright © 2011. Nova Science Publishers, Incorporated. All rights reserved. A Practical Guide to Reflux: Causes, Consequences and Care : Causes, Consequences and Care, Nova Science Publishers,

Copyright © 2011. Nova Science Publishers, Incorporated. All rights reserved.

Preface This book provides a comprehensive look at this common disease written in medical journal style but designed to be read by anyone with an interest in the condition. The book can be used as a reference source or as a general knowledge enhancer. The volume contains hard to find practical advice on testing and treatment of reflux with helpful nuances from an experienced practitioner. The various advanced technologies to diagnose reflux such as wireless pH monitoring, sedationless endoscopy and Capsule endoscopy are reviewed. Also included is a learned discussion about the recent topic of nonacid reflux and how reflux relates to motility disorders of the esophagus. Alternatives to medications are discussed along with practice experience on their success. Chapter 1 - Gastroesophageal reflux disease (GERD) is a widespread illness which can affect any population groups but is more prevalent in certain patient populations. It is important to identify and have knowledge of these specific groups as both the quality of life and complications of GERD can be more easily managed when the disease is identified early in its course. Epidemiological factors such as locale, diet, smoking, obesity and family history are clearly associated with an increase prevalence of GERD. However other factors such as sex, age and race are not as strongly linked with the overall prevalence of GERD. Chapter 2 - Gastroesophageal reflux is one of the most common clinical problems encountered today. It is a condition in which there is reflux of gastric contents into the esophagus which provokes symptoms that may lead to complications and impairment of quality of life.

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viii

Preface

The pathophysiology of GERD is complex and not entirely understood abnormalities of the gastroesophageal junction, the stomach and the nervous system may all contribute to the disease. Additionally, environmental factors also influence the development of GERD. Long term consequences of prolonged GERD can lead to the development of greater complications such as erosions, strictures, ulcers, Barrett’s esophagus and adenocarcinoma if left untreated. The pathophysiology and consequences of GERD are reviewed here. Chapter 3 - The American College of Gastroenterology (ACG) defines gastroesophageal reflux disease (GERD) as the presence of symptoms or mucosal injury resulting from the abnormal reflux of gastric contents into the esophagus. [1] The clinical presentation of patients with GERD can be quite varied with some patients presenting with “typical” symptoms such as heartburn and regurgitation of food and others presenting with “atypical” symptoms like chest pain, hoarseness, wheezing and chronic cough. After obtaining a careful history, a decision to medically treat GERD can be made. GERD without prolonged symptoms or alarm features, such as dysphagia (difficulty swallowing), weight loss or gastrointestinal bleeding can be treated empirically for six to eight weeks with acid suppression therapy. A clinical response to treatment can confirm the suspected diagnosis. On the other hand, patients with daily or prolonged symptoms, usually greater than ten years, or with alarm features should undergo further diagnostic evaluation. It is of paramount importance to rule out coronary artery disease. Chapter 4 - Gastroesophageal reflux disease (GERD) is a multifactorial process, one of the most common gastrointestinal diseases, and a costly problem to manage. It accounts for at least 9 million physician office visits in the United States (US) every year. The annual direct cost for managing the disease is estimated to be more than $9 billion dollars in the US. In western populations, 20% of people over age 30 report having heartburn at least once a month; 12% at least once per week; and 5% describe daily symptoms. However, the prevalence of the disease tends to be underestimated, with unrecognized GERD occurring in more than 50% of patients seen in general practice for unrelated conditions and this compounds treatment. When recognized the treatment options available for GERD range from over-thecounter (OTC) antacids to proton pump inhibitors (PPIs) along with therapies of endolumenal endoscopic therapies and surgery. This chapter will review the various treatment options for GERD.

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In: A Practical Guide to Reflux Editor: John W. Birk

ISBN 978-1-61324-922-2 © 2012 Nova Science Publishers, Inc.

Chapter 1

Gastroesophageal Reflux Disease: Incidence and Epidemiology Deepika Devuni

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University of Connecticut School of Medicine Division of Gastroenterology-Hepatology, Connecticut, U.S.

Abstract: Gastroesophageal reflux disease (GERD) is a widespread illness which can affect any population groups but is more prevalent in certain patient populations. It is important to identify and have knowledge of these specific groups as both the quality of life and complications of GERD can be more easily managed when the disease is identified early in its course. Epidemiological factors such as locale, diet, smoking, obesity and family history are clearly associated with an increase prevalence of GERD. However other factors such as sex, age and race are not as strongly linked with the overall prevalence of GERD. Keywords: GERD (Gastroesophageal Reflux Disease), Incidence, Risk Factors, Economic Impact.

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2

.

Deepika Devuni

Introduction: Gastroesophageal reflux disease constitutes the presence of symptoms or evidence of mucosal damage by reflux. Heartburn and regurgitation are two symptoms which can be present. GERD has quite a negative impact on quality of life and the long term complications of GERD include the development of strictures, Barrett’s esophagus or adenocarcinoma of the esophagus. Gastroesophageal reflux disease is one of the top five gastrointestinal disorders with respect to health care spending. Multiple cost benefit analyses have been performed to determine the most cost effective treatment for this disease and treatment should not be ignored. The presence of GERD can significantly impact a person’s quality of life (QOL). GERD has been shown to impact all parts of a patient’s life- physical, emotional, mental health and social functioning. The aggressive treatment of the disease can result in significant improvement in QOL.

Incidence and Prevalence of GERD:

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Prevalence: Dent et al [1] published a review on the epidemiology of GERD in 2005. In their review they quoted two studies which reporting the incidence of GERD. The first study was based in the UK and showed an overall incidence of GERD of 4.5 per 1000 person years (95% confidence interval 4.4-4.7). The second study was based in United States and estimated the incidence of GERD to be 5.4 per 1000 person years. Most of the data currently available regarding the epidemiology of GERD is derived from studies utilizing patient questionnaires. In these studies, the prevalence of GERD in western countries is higher than in Asia but this maybe an investigational bias. North America: Data is available from patients residing in Olmsted County, Minnesota [2, 3]. They used a validated GERD questionnaire to assess its prevalence. The prevalence of weekly heartburn and/ or acid regurgitation was 20%. The presence of weekly heartburn alone was 17.8% and weekly regurgitation was 6.6%. Even though this is the most comprehensive study performed in the United States, this is not a representative of the general population of the country as the patients included in the study were predominantly Caucasian. Talley et al [4] conducted a similar study in 1992 on a urban population. The prevalence reported by that study was 13.2% for weekly

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Gastroesophageal Reflux Disease

3

heartburn and 6.5% for weekly regurgitation. in an urban. A recently published study by El-Serag et al’s [5] focuses on the ethnic variation in the prevalence of GERD. The study was conducted on 915 subjects, who were employees of Houston Veteran Affairs Medical Center. These subjects were also given a validated GERD questionnaire. At least weekly heartburn was reported in 27.4% of black participants, 23.4% of white participants and 23.9% of other races. There was no statistically significant difference in the prevalence of symptoms among the different racial groups. Europe: In a study done by Mohammed et al [6], 1960 twin pairs were evaluated for GERD symptoms. The prevalence of weekly GERD was 18% in both mono- and dizygotic twins. The investigators thought genetic factors may contribute to the presence of GERD but other factors were clearly in play. Another study performed in the United Kingdom (UK) by Thompson WG et al [7], showed at least a weekly prevalence of GERD symptoms in 10.3% of participants Asia: China: In a recent study by He et al [8], a total of 16, 091 participants from all five regions of China were asked to complete a survey. Based on the data obtained, the reported prevalence of weekly GERD symptoms in China is 3.1 %, which is much lower in comparison to Western Countries. Ma et al [9] published a study in 2008 which showed that the prevalence of at least weekly heartburn and/ or regurgitation in Shanghai was 6.2%. Although overall the prevalence of GERD in China seems lower than the western hemisphere their seems to be regional differences. The lifestyle changes occurring in China will make this an interesting trend to follow. India: In 2010, 4079 employee’s of the All India Institute were surveyed for GERD symptoms and found to have weekly symptom prevalence of 5.9%. [10] In this study risk factors for GERD were sedentary lifestyle, smoking and BMI greater than 25. It is of interest to note that inhabitants of the rural high altitude areas of India may also have a high prevalence of GERD. Kumar et al [11] reported that 8.0% of people living above 3000m had weekly GERD symptoms. Altitudes along with other known factors were found to be significant.

Risk Factors: Age: It is unclear whether increasing age is a risk factor for GERD. There are studies that have shown a slight increase in the incidence of GERD with increasing age. An Olmsted County study showed no increase in the incidence of GERD with increasing age. [2] A UK GP database review shows a tendency

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4

Deepika Devuni

toward increase in GERD incidence until 69 years of age after which it declined.[11] Sex: GERD is more common in males than females. Multiple studies.[12,13] have confirmed the same. Eslick et al [14] showed that prevalence of GERD in males and females was 57% and 54% respectively (men vs women, p=0.01). In patients over 70 years, females (8%) had a higher rate of symptoms than males (3%). (p