Welcome back. Thanks for joining me on this discussion of stomach gastroesophageal reflux disease
in this section of general surgery. Reflux is incredibly common. In fact, some reflux of the stomach
content into the esophagus is physiologic. Therefore, not all reflux is pathologic. Most episodes however
are very brief. You probably have had a few episodes of reflux yourself after a hard exam or right before
one, if one is nervous. Officially though, the diagnosis of gastroesophageal reflux results in symptoms
or complications such as esophagitis, chest pain, or disturbances in quality of life.
So, what does that mean? Patients go beyond the intermittent brief episodes of self-contained reflux.
These patients have significant symptoms that last for a long time. What are some common history
and physical findings? Heartburn, regurgitation, these are common. In fact, some patients
complaining of chest pain/cough and when they come to the emergency department complaining
of chest pain, one gets very worried that it’s in fact, the patient having a myocardial infarction
or heart attack. It’s important to keep that in differential but common things being common,
these patients sometimes present with atypical chest pain. Patients can also describe dysphagia
or difficulty swallowing after prolonged esophagitis or inflammation of the esophagus
as well as water brash. Water brash leads to hypersalivation due to particularly the recumbent reflux
of gastric content into the proximal esophagus. Additionally, many patients feel some nausea
and vomiting with chronic reflux disease. Laboratories generally are not very helpful.
Your chemistries and your CBCs can be completely normal. So, how do we diagnose?
We proceed with an upper endoscopy. In this picture of an endoscopy, you show signs of esophagitis.
Some patients undergo 24-hour pH monitoring. The gastroesophageal reflux disease is diagnosed
when there’s persistent disease despite initial treatment and the pH monitoring records
a percentage of time where the pH drops below 4 in the esophagus. Recall that intermittent,
brief episodes of reflux may be physiologic. Therefore, the overall percentage of time
where the pH drops below 4 in the esophagus as evidence or indirect evidence of exposure
to gastric content which as you know is very acidic.