Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

GERD · Gastroesophageal Reflux Disease

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In one line

·Stomach acid flows backward into the food tube, burning it over and over.

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Normal physiology

·At the bottom of your food tube (esophagus), a ring of muscle called the lower esophageal sphincter (LES) opens to let food into the stomach, then clamps shut like a one-way door. The stomach makes strong acid to digest food and has a thick mucus coat to protect itself. The food tube has no such armor — it is built to move food, not handle acid.

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What goes wrong

·The muscle door (LES) at the bottom of the food tube loses its squeeze or relaxes at the wrong times, letting stomach acid splash upward where it does not belong.

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Hallmark signs

·Burning feeling in the chest (heartburn)
·Sour or bitter taste in the mouth (regurgitation)
·Trouble swallowing (dysphagia)
·Chest pain (non-cardiac chest pain)
·Chronic cough or throat clearing
·Hoarse voice or sore throat
·Worsening asthma or wheezing
·Unintended weight loss

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Red flags · escalate now

·Trouble swallowing or pain when swallowing
·Unintended weight loss
·Vomiting blood or passing black, tarry stools
·New reflux symptoms starting after age 60
·Anemia (low red blood cell count) without an obvious cause

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Workup

·Clinical diagnosis (history and symptom response to PPI trial)
·Upper endoscopy (esophagogastroduodenoscopy, EGD)
·Ambulatory 24-hour esophageal pH monitoring (or pH-impedance)
·Esophageal manometry
·Barium esophagram (upper GI series)
·Empiric PPI trial (omeprazole 20–40 mg daily or equivalent for 8 weeks)

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Treatment

·Proton pump inhibitor (PPI) once daily 30–60 minutes before breakfast for 8 weeks (e.g. omeprazole 20 mg, esomeprazole 40 mg, pantoprazole 40 mg)
·Lifestyle modification: lose weight if BMI > 25, elevate head of bed 6–8 inches, avoid meals 2–3 hours before lying down
·Avoid trigger foods and substances: caffeine, alcohol, chocolate, peppermint, fatty or spicy foods, smoking cessation
·H₂-receptor antagonist at bedtime if breakthrough nighttime symptoms (e.g. famotidine 20 mg)
·Alginate-antacid combination after meals (e.g. Gaviscon)
·Upper endoscopy if alarm features present (dysphagia, painful swallowing (odynophagia), GI bleeding, weight loss, age > 60 with new-onset symptoms, family history of GI cancer)
·Anti-reflux surgery (laparoscopic Nissen fundoplication) if medical therapy fails or patient prefers to stop lifelong PPI

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NCLEX trap

·Ask about alarm signs FIRST. Alarm signs mean the patient needs endoscopy (a camera test down the throat) to look for damage or cancer, not just a PPI. Red flags include trouble swallowing, losing weight without trying, bleeding, vomiting, or chest pain.
·GERD causes a chain of problems — acid bathes the esophagus (food tube), which can lead to scars, narrowing, Barrett's esophagus (cell changes that raise cancer risk), and esophageal cancer. You must think downstream and watch for these over time.
·GERD acid can splash up into the larynx (voice box) and lungs, irritating the airways. Always ask about reflux when a patient has a chronic cough, asthma that won't quit, or hoarseness — especially if it's worse at night or after meals.
·PPIs work by shutting off acid pumps in the stomach, but long-term use has real risks: low magnesium and B12 (the stomach needs acid to absorb them), weak bones (higher fracture risk), kidney disease, and C. diff infections. Use the lowest dose for the shortest time that controls symptoms, and check labs yearly if the patient stays on a PPI.
·Lifestyle changes ARE part of the real fix for GERD — they lower pressure on the stomach and keep the lower esophageal sphincter (LES, the valve at the bottom of the food tube) tight. Lose weight if overweight, raise the head of the bed 6–8 inches, eat dinner 3 hours before bed, avoid triggers (chocolate, peppermint, caffeine, alcohol, tomatoes, spicy or fatty foods), and quit smoking.
·Test for H. pylori (a bacteria that burrows into the stomach lining and causes ulcers) if GERD comes with an ulcer. Use a urea breath test, stool antigen, or biopsy during endoscopy. If positive, treat with triple therapy: a PPI plus two antibiotics (usually amoxicillin and clarithromycin, or metronidazole if penicillin-allergic) for 14 days.

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