Gastroesophageal reflux disease (GERD) is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus and causes GERD signs and symptoms. Signs and symptoms of GERD include acid reflux and heartburn. Both are common digestive conditions that many people experience from time to time. When these signs and symptoms occur at least twice each week or interfere with your daily life, doctors call this GERD.

Mechanism: When one swallows, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into the stomach. Then it closes again. However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into the esophagus, causing frequent heartburn. This constant backwash of acid can irritate the lining of the esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems. (from Mayo Clinic webpage -edited)New guidelines on the diagnosis and management of gastroesophageal reflux disease appear in the American Journal of Gastroenterology. Among the strong recommendations with the highest level of evidence:

• Physicians should not use barium radiographs to diagnose the condition.
• Use an 8-week course of proton-pump inhibitors (PPIs) for symptom relief and healing of erosive esophagitis.
• The various PPIs show the same level of efficacy. (Nexium is like Prevacid, Prilosec,…etc)
• There is not an increased risk for adverse cardiovascular events among PPI users taking Plavix (clopidogrel).

Comments: GERD is a common complaint among all patients; insurance companies have always tried to push subscribers to use over the counter medications instead of prescription drugs, for financial reasons. These guidelines support the use of any PPI! BA

Reference:  American Journal of Gastroenterology article (Free PDF)