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Gastroesophageal Reflux Disease

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Gastrointestinal and Liver Disorders in Women’s Health

Abstract

Gastroesophageal reflux disease (GERD) affects up to three in ten adult women Americans and can present with symptoms and/or erosive complications. Typical symptoms of GERD include heartburn and regurgitation, though atypical and extraesophageal symptom presentations of GERD also frequently need evaluation. First-line treatment options for GERD are lifestyle interventions and may include pharmacologic gastric acid suppression. Proton pump inhibitor (PPI) therapy is most commonly trialed for gastric acid suppression, and with increasing utilization of PPI therapy, GERD less commonly manifests with erosive esophageal injury such as severe esophagitis and peptic strictures. GERD remains a known risk factor for development of Barrett’s esophagus which may further progress to esophageal adenocarcinoma, though women are less likely to develop Barrett’s esophagus. Up to 40% of patients with symptoms of GERD will not respond adequately to PPI therapy, and this group warrants further diagnostic evaluation with endoscopy and ambulatory reflux monitoring. Expanding treatment options for PPI nonresponsive GERD include adjunctive pharmacologic therapy to further attempt to decrease the reflux burden, neuromodulation, psychologic interventions, and anti-reflux interventions, including surgical and endoluminal approaches. The current paradigm of GERD management is shifting toward a personalized approach, utilizing physiologic testing to understand a particular patient mechanism of reflux and guide an evidence-based and patient-centered therapeutic plan.

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Abbreviations

GERD:

Gastroesophageal reflux disease

GI:

Gastrointestinal

H2RAs:

Histamine-2 receptor antagonists

IBS:

Irritable bowel syndrome

LES:

Lower esophageal sphincter

P-CABs:

Potassium-competitive acid blockers

PPI:

Proton pump inhibitor

TIF:

Transoral incisionless fundoplication

TLESRs:

Transient lower esophageal sphincter relaxations

TRIM:

The reflux improvement monitoring

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Disclosures

Conflicts of Interest: RY, Consultant, Ironwood, Diversatek Healthcare, Medtronic. AK, Consultant, Medtronic.

Research Funding: RY, supported by NIH R01 DK092217 (Pandolfino) and ACG Junior Faculty Development Award (Yadlapati).

Author information

Authors and Affiliations

  1. Division of Gastroenterology & Hepatology, University of California San Diego, San Diego, CA, USA

    Rena Yadlapati

  2. Division of Gastroenterology & Hepatology, Center for Esophageal Disease, New York University, New York, NY, USA

    Abraham Khan

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  1. Rena Yadlapati
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  2. Abraham Khan
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Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA

    Poonam Beniwal-Patel

  2. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA

    Reza Shaker

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Yadlapati, R., Khan, A. (2019). Gastroesophageal Reflux Disease. In: Beniwal-Patel, P., Shaker, R. (eds) Gastrointestinal and Liver Disorders in Women’s Health . Springer, Cham. https://doi.org/10.1007/978-3-030-25626-5_3

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  • DOI: https://doi.org/10.1007/978-3-030-25626-5_3

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  • Online ISBN: 978-3-030-25626-5

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