Gastroesophageal reflux disease GERD

• History / PE:
  Retrosternal burning
  Chronic cough
  Hoarseness
  Water brash (regurgitation of sour fluid into the mouth)
  Asthma -like symptoms that only occur at night
• Diagnosis:
  24-hour pH recording
  Endoscopy
• Treatment:
  H2 receptor antagonist (eg. ranitidine)
  Proton pump inhibitor (eg. omeprazole)
  Surgical fundoplication (refractory to medical therapy)
• Complications:
  Barrett's esophagus
  Peptic stricture formation
  Erosive esophagitis
• Notes:
  In infants, GERD manifested by "posturing of Sandifer's syndrome" (tilted head and arched back)
• See Also:
  Peptic ulcer disease
• Differential Diagnosis:
  Acute coronary syndrome
  Costochondritis