prokinetic agent (Reglan, Cisapride)
proton pump inhibitor (Prilosec, Prevacid)
combination therapy
Though it may sound like a common condition, one would be wrong to assume that this condition has little sequlae. Patients with GERD have twice the risk of those without reflux for developing lung (pneumonia, bronchitis, asthma, pulmonary fibrosis, C.O.P.D.), pharyngeal (pharyngitis), laryngeal (laryngitis, aphonia) and sinus diseases in one large study. One must be sure not to forget about its importance in causing significant esophagitis. This can not only mimic myocardial ischemia but in the long run is associated with an increase risk of malignancy. Barrett's esophagus is found in approximately 10% of symptomatic patients with G.E.R.D.. Currently there is still no consensus on managing patients with Barrett's. The American College of Gastroenterology is planning to put out clinical guidelines regarding whom and how often endoscopic surveillance should be performed in some time this year.
Esophageal adenocarcinoma is one of only two cancers (malignant melanoma being the other) that have shown a consistent rise in incidence and mortality over the last two decades, a period in which other cancers have declined or remained stable. Barrett's esophagus is clearly a precursor to adenocarcinoma.
Note the proximally displaced squamocolumnar junction and moderately to severely inflamed mucosa. On biopsy, this revealed a that the normal stratified squamous epithelium was replaced by metaplastic, specialized, columnar glandular epithelium.
