Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder in men. It is estimated that it affects 18.6 million people in the United States. In the US adult population, 10-20% of people have symptoms at least once weekly and 15-40% of people have symptoms at least once monthly. Among adult patients with GERD who seek medical care, up to 20% have serious complications. Although there is a tendency to reduced symptom frequency of the usual complaints of heartburn and acid regurgitation in older men, the frequency of GERD complications is significantly higher than in younger men.
GERD has direct impact on quality of life, especially in those with nighttime GERD symptoms. It can negatively effect sleep and work performance. It also has a significant economic impact with direct costs totaling 9.3 billion dollars and indirect costs totaling 75 billion dollars in the U.S.
GERD is a condition that develops when reflux of gastric contents causes troublesome symptoms and/or complications. Injury to the esophagus is usually due to reflux of gastric acid and the digestive enzyme pepsin. However, reflux of bile rather than acid may also cause esophageal injury in some people. The lower esophageal sphincter muscle (LES) is the antireflux barrier. GERD most often occurs as a result of transient LES relaxations (tLESRs), the drop in LES pressure not accompanied by swallowing which promotes acid reflux and the constellation of GERD problems. Other abnormalities that can cause GERD include defective mechanisms of esophageal clearance, salivary production, esophageal mucosal (lining cells) resistance to damage and abnormalities of gastric emptying.
Lifestyle factors can be associated with increased gastroesophageal reflux and more complications of GERD. Tobacco smoking, caffeine, alcohol and fatty foods adversely affect GERD. Obesity, sedentary lifestyle and nocturnal gastroesophageal reflux are important mechanisms of GERD that are associated with more severe complications of GERD in men.
Many diseases can be associated with GERD, such as Parkinson’s disease and other neurological diseases, heart disease, lung disease and diabetes. Medications more frequently taken by men for illnesses such as hypertension, heart disease, lung disease and depression also decrease LES pressure and esophageal acid clearance. These include nitrates, calcium channel blockers, benzodiazepines, anticholinergic agents, and antidepressants. Direct esophageal injury can be caused by medicines such as occur nonsteroidal anti-inflammatory drugs (NSAIDs), potassium tablets, iron supplements and biphosphonates A hiatal hernia and the loss of the diaphragmatic “pinch” may impair the function of the LES and the clearance of refluxed acid from the distal esophagus.
The most common symptoms of GERD are heartburn and acid regurgitation. Heartburn is a burning pain in the upper abdomen or chest that may radiate to the neck, throat and back. It often occurs after large meals, exercise or reclining. Other common symptoms include water brash, belching and nausea. Important warning symptoms that herald more severe disease include difficult swallowing, termed dysphagia, painful swallowing, termed odynophagia, anemia, unexplained weight loss and gastrointestinal bleeding. These signal a more severe problem, such as severe esophagitis, esophageal ulcer, esophageal stricture, Barrett’s esophagus and even esophageal cancer.
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