Heartburn Acid Reflux Relief

<div id="globalWrapper"> <div id="column-content"> <div id="content"> <a name="top" id="top"></a> <div id="siteNotice"><script type='text/javascript'>if (wgNotice != '') document.writeln(wgNotice);</script></div> <h1 id="firstHeading" class="firstHeading">Gastroesophageal reflux disease</h1> <div id="bodyContent"> <h3 id="siteSub">From Wikipedia, the free encyclopedia</h3> <div id="contentSub"> (Redirected from <a href="/w/index.php?title=Acid_reflux&redirect=no" title="Acid reflux">Acid reflux</a>)</div> <div id="jump-to-nav">Jump to: <a href="#column-one">navigation</a>, <a href="#searchInput">search</a></div>  <table class="infobox" cellspacing="5" style="width: 22em; text-align: left; font-size: 88%; line-height: 1.5em;"> <tr> <td colspan="2" class="" style="text-align:center; font-size: 125%; font-weight: bold; background-color: lightgrey">Gastroesophageal reflux disease</td> </tr> <tr> <td colspan="2" class="" style="text-align:center;"><i>Classification and external resources</i></td> </tr> <tr> <td colspan="2" class="" style="text-align:center;"><a href="/wiki/File:Gastroesophageal_reflux_barium_X-ray.jpg" class="image" title="Gastroesophageal reflux barium X-ray.jpg"><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/5/56/Gastroesophageal_reflux_barium_X-ray.jpg/190px-Gastroesophageal_r eflux_barium_X-ray.jpg" width="190" height="232" /></a><br /> <span style="">X-ray of the abdomen and chest in a patient with a <a href="/wiki/Gastrostomy" title="Gastrostomy">gastrostomy</a>. <a href="/wiki/Radiocontrast" title="Radiocontrast">Radiocontrast</a> was injected into the stomach and quickly seen migrating upwards through the entire <a href="/wiki/Esophagus" title="Esophagus">esophagus</a>. The patient had severe reflux-induced <a href="/wiki/Esophagitis" title="Esophagitis">esophagitis</a>.</span></td> </tr> <tr> <th style=""><a href="/wiki/ICD" title="ICD" class="mw-redirect">ICD</a>-<a href="/wiki/List_of_ICD-10_codes" title="List of ICD-10 codes" class="mw-redirect">10</a></th> <td class="" style=""><a href="/wiki/ICD-10_Chapter_K" title="ICD-10 Chapter K" class="mw-redirect">K</a><a href="http://apps.who.int/classifications/apps/icd/icd10online/?gk20.htm+k21" class="external text" title="http://apps.who.int/classifications/apps/icd/icd10online/?gk20.htm+k21" rel="nofollow">21.</a></td> </tr> <tr> <th style=""><a href="/wiki/ICD" title="ICD" class="mw-redirect">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9</a></th> <td class="" style=""><a href="http://www.icd9data.com/getICD9Code.ashx?icd9=530.81" class="external text" title="http://www.icd9data.com/getICD9Code.ashx?icd9=530.81" rel="nofollow">530.81</a></td> </tr> <tr> <th style=""><a href="/wiki/OMIM" title="OMIM" class="mw-redirect">OMIM</a></th> <td class="" style=""><a href="http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=109350" class="external text" title="http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=109350" rel="nofollow">109350</a></td> </tr> <tr> <th style=""><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></th> <td class="" style=""><a href="http://www.diseasesdatabase.com/ddb23596.htm" class="external text" title="http://www.diseasesdatabase.com/ddb23596.htm" rel="nofollow">23596</a></td> </tr> <tr> <th style=""><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></th> <td class="" style=""><a href="http://www.emedicine.com/med/topic857.htm" class="external text" title="http://www.emedicine.com/med/topic857.htm" rel="nofollow">med/857</a>  <a href="http://www.emedicine.com/ped/topic1177.htm#" class="external text" title="http://www.emedicine.com/ped/topic1177.htm#" rel="nofollow">ped/1177</a> <a href="http://www.emedicine.com/radio/topic300.htm#" class="external text" title="http://www.emedicine.com/radio/topic300.htm#" rel="nofollow">radio/300</a></td> </tr> <tr> <th style=""><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></th> <td class="" style=""><a href="http://www.nlm.nih.gov/cgi/mesh/2009/MB_cgi?field=uid&term=D005764" class="external autonumber" title="http://www.nlm.nih.gov/cgi/mesh/2009/MB_cgi?field=uid&term=D005764" rel="nofollow">[2]</a></td> </tr> </table> <p><b>Gastroesophageal reflux disease</b> <b>(GERD)</b>, <b>Gastro-oesophageal reflux disease</b> <b>(GORD)</b>, <b>Gastric reflux disease</b>, or <b>Acid reflux disease</b> is defined as chronic symptoms or <a href="/wiki/Mucosa" title="Mucosa" class="mw-redirect">mucosal</a> damage produced by the abnormal reflux in the <a href="/wiki/Esophagus" title="Esophagus">esophagus</a>.<sup id="cite_ref-0" class="reference"><a href="#cite_note-0"><span>[</span>1<span>]</span></a></sup></p> <p>This is commonly due to transient or permanent changes in the barrier between the esophagus and the <a href="/wiki/Stomach" title="Stomach">stomach</a>. This can be due to incompetence of the <a href="/wiki/Lower_esophageal_sphincter" title="Lower esophageal sphincter" class="mw-redirect">lower esophageal sphincter</a>, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, or a <a href="/wiki/Hiatal_hernia" title="Hiatal hernia" class="mw-redirect">hiatal hernia</a>. If the reflux reaches the throat, it is called <a href="/wiki/Laryngopharyngeal_reflux_disease" title="Laryngopharyngeal reflux disease" class="mw-redirect">laryngopharyngeal reflux disease</a>.</p> <table id="toc" class="toc" summary="Contents"> <tr> <td> <div id="toctitle"> <h2>Contents</h2> </div> <ul> <li class="toclevel-1"><a href="#Signs_and_symptoms"><span class="tocnumber">1</span> <span class="toctext">Signs and symptoms</span></a> <ul> <li class="toclevel-2"><a href="#Adults"><span class="tocnumber">1.1</span> <span class="toctext">Adults</span></a></li> <li class="toclevel-2"><a href="#Children"><span class="tocnumber">1.2</span> <span class="toctext">Children</span></a></li> <li class="toclevel-2"><a href="#Barrett.27s_esophagus"><span class="tocnumber">1.3</span> <span class="toctext">Barrett's esophagus</span></a></li> </ul> </li> <li class="toclevel-1"><a href="#Diagnosis"><span class="tocnumber">2</span> <span class="toctext">Diagnosis</span></a></li> <li class="toclevel-1"><a href="#Pathophysiology"><span class="tocnumber">3</span> <span class="toctext">Pathophysiology</span></a></li> <li class="toclevel-1"><a href="#Treatment"><span class="tocnumber">4</span> <span class="toctext">Treatment</span></a> <ul> <li class="toclevel-2"><a href="#Lifestyle_modifications"><span class="tocnumber">4.1</span> <span class="toctext">Lifestyle modifications</span></a></li> <li class="toclevel-2"><a href="#Medications"><span class="tocnumber">4.2</span> <span class="toctext">Medications</span></a></li> <li class="toclevel-2"><a href="#Surgical_treatments"><span class="tocnumber">4.3</span> <span class="toctext">Surgical treatments</span></a></li> <li class="toclevel-2"><a href="#Other_treatments"><span class="tocnumber">4.4</span> <span class="toctext">Other treatments</span></a></li> </ul> </li> <li class="toclevel-1"><a href="#References"><span class="tocnumber">5</span> <span class="toctext">References</span></a></li> <li class="toclevel-1"><a href="#External_links"><span class="tocnumber">6</span> <span class="toctext">External links</span></a></li> </ul> </td> </tr> </table> <script type="text/javascript"> //<![CDATA[ if (window.showTocToggle) { var tocShowText = "show"; var tocHideText = "hide"; showTocToggle(); } //]]> </script> <p><a name="Signs_and_symptoms" id="Signs_and_symptoms"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=1" title="Edit section: Signs and symptoms">edit</a>]</span> <span class="mw-headline">Signs and symptoms</span></h2> <p><a name="Adults" id="Adults"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=2" title="Edit section: Adults">edit</a>]</span> <span class="mw-headline">Adults</span></h3> <p>The most-common symptoms of GERD are:</p> <ul> <li><a href="/wiki/Heartburn" title="Heartburn">Heartburn</a></li> <li><a href="/wiki/Regurgitation_(digestion)" title="Regurgitation (digestion)">Regurgitation</a></li> <li>Trouble swallowing (<a href="/wiki/Dysphagia" title="Dysphagia">dysphagia</a>)</li> </ul> <p>Less-common symptoms include:</p> <ul> <li>Pain with swallowing (<a href="/wiki/Odynophagia" title="Odynophagia">odynophagia</a>)</li> <li>Excessive salivation (this is common during heartburn, as saliva is generally slightly basic<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span>[</span>2<span>]</span></a></sup> and is the body's natural response to heartburn, acting similarly to an antacid)</li> <li>Nausea<sup id="cite_ref-Kahrilas_2-0" class="reference"><a href="#cite_note-Kahrilas-2"><span>[</span>3<span>]</span></a></sup></li> <li>Chest pain</li> </ul> <p>GERD sometimes causes injury of the esophagus. These injuries may include:</p> <ul> <li><a href="/wiki/Reflux_esophagitis" title="Reflux esophagitis" class="mw-redirect">Reflux esophagitis</a>—<a href="/wiki/Necrosis" title="Necrosis">necrosis</a> of esophageal epithelium causing ulcers near the junction of the stomach and esophagus.</li> <li><a href="/wiki/Esophageal_stricture" title="Esophageal stricture">Esophageal strictures</a>—the persistent narrowing of the esophagus caused by reflux-induced inflammation.</li> <li><a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a>—<a href="/wiki/Metaplasia" title="Metaplasia">metaplasia</a> (changes of the epithelial cells from squamous to columnar epithelium) of the distal esophagus.</li> <li><a href="/wiki/Esophageal_adenocarcinoma" title="Esophageal adenocarcinoma" class="mw-redirect">Esophageal adenocarcinoma</a>—a rare form of cancer.<sup id="cite_ref-Kahrilas_2-1" class="reference"><a href="#cite_note-Kahrilas-2"><span>[</span>3<span>]</span></a></sup></li> </ul> <p>Several other atypical symptoms are associated with GERD, but there is good evidence for causation only when they are accompanied by esophageal injury. These symptoms are:</p> <ul> <li>Chronic cough</li> <li><a href="/wiki/Laryngitis" title="Laryngitis">Laryngitis</a> (hoarseness, throat clearing)</li> <li><a href="/wiki/Asthma" title="Asthma">Asthma</a></li> <li>Erosion of dental enamel</li> <li><a href="/wiki/Dentine_hypersensitivity" title="Dentine hypersensitivity">Dentine hypersensitivity</a></li> <li>Sinusitis and damaged teeth<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span>[</span>4<span>]</span></a></sup></li> </ul> <p>Some people have proposed that symptoms such as <a href="/wiki/Pharyngitis" title="Pharyngitis" class="mw-redirect">pharyngitis</a>, <a href="/wiki/Sinusitis" title="Sinusitis">sinusitis</a>, recurrent ear infections, and <a href="/wiki/Idiopathic_pulmonary_fibrosis" title="Idiopathic pulmonary fibrosis">idiopathic pulmonary fibrosis</a> are due to GERD; however, a causative role has not been established.<sup id="cite_ref-Kahrilas_2-2" class="reference"><a href="#cite_note-Kahrilas-2"><span>[</span>3<span>]</span></a></sup></p> <p><a name="Children" id="Children"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=3" title="Edit section: Children">edit</a>]</span> <span class="mw-headline">Children</span></h3> <p>GERD may be difficult to detect in <a href="/wiki/Infant" title="Infant">infants</a> and <a href="/wiki/Child" title="Child">children</a>. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>, effortless spitting up, <a href="/wiki/Coughing" title="Coughing" class="mw-redirect">coughing</a>, and other respiratory problems. Inconsolable crying, failure to gain adequate weight, refusing food, bad breath, and <a href="/wiki/Belching" title="Belching">belching</a> or <a href="/wiki/Burping" title="Burping" class="mw-redirect">burping</a> are also common. Children may have one symptom or many — no single symptom is universal in all children with GERD.</p> <p><b>Common symptoms of Paediatric Reflux</b></p> <ul> <li>Irritability and pain, sometimes screaming suddenly when asleep. Constant or sudden crying or “colic” like</li> </ul> <p>symptoms. Babies can be inconsolable especially when laid down flat.</p> <ul> <li>Poor sleep habits typically with arching their necks and back during or after feeding</li> <li>Excessive possetting or vomiting</li> <li>Frequent burping or frequent hiccups</li> <li>Excessive dribbling or running nose</li> <li>Swallowing problems, gagging and choking</li> <li>Frequent ear infections or sinus congestion</li> <li>Babies are often very gassy and extremely difficult to “burp” after feeds</li> <li>Refusing feeds or frequent feeds for comfort</li> <li>Night time coughing, extreme cases of acid reflux can cause apnoea and respiratory problems such as asthma, bronchitis and pneumonia if stomach contents are inhaled.</li> <li>Bad breath – smelling acidy</li> <li>Rancid/acid smelling diapers with loose stool. Bowel movements can be very frequent or babies can be constipated.</li> </ul> <p><b>Vomiting feeds</b> Possetting after a feed is quite normal with most infants. They gain weight, feed well and have no other symptoms, but still this can be upsetting for parents. As the child gets older the lower oesophageal sphincter becomes more competent so the vomiting should begin to show signs of improvement and eventually stop. Some babies suffer more with reflux and about 60% of these babies with persistent reflux may have weight gain issues. <i>It is a very popular misconception</i> though that all babies and children with reflux are underweight<i>. This isn't always the case, some may comfort eat and</i> feed very frequently and not all are sick. Many doctors advise that babies outgrow reflux once they can sit up, or once they stand. Many do, but some will not only fail to outgrow it, but will noticeably worsen with developmental milestones, teething episodes, viral illness and weaning.</p> <p><b>Silent Reflux</b> Some babies with reflux do not vomit at all. This is actually more of a problem because the acidic stomach contents go up the throat and back down again, causing twice the pain and twice the damage.<sup class="noprint Template-Fact" title="This claim needs references to reliable sources from March 2009" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a></i>]</sup> There is no clear relationship between symptoms and the severity of reflux.</p> <p>It is estimated that of the approximately 4 million babies born in the U.S. each year, up to 35% of them may have difficulties with reflux in the first few months of their life, known as <i>spitting up</i>.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span>[</span>5<span>]</span></a></sup> Most of those children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true where there is a family history of GERD present.</p> <p><a name="Barrett.27s_esophagus" id="Barrett.27s_esophagus"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=4" title="Edit section: Barrett's esophagus">edit</a>]</span> <span class="mw-headline">Barrett's esophagus</span></h3> <div class="rellink noprint relarticle mainarticle">Main article: <a href="/wiki/Barrett%27s_Esophagus" title="Barrett's Esophagus" class="mw-redirect">Barrett's Esophagus</a></div> <p>GERD may lead to <a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a>, a type of <a href="/wiki/Metaplasia" title="Metaplasia">metaplasia</a> which is in turn a precursor condition for carcinoma. The risk of progression from Barrett's to dysplasia is uncertain but is estimated at about 20% of cases.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span>[</span>6<span>]</span></a></sup> Due to the risk of chronic heartburn progressing to Barrett's, EGD every 5 years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD.<sup class="noprint Template-Fact" title="This claim needs references to reliable sources from June 2009" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a></i>]</sup></p> <p><a name="Diagnosis" id="Diagnosis"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=5" title="Edit section: Diagnosis">edit</a>]</span> <span class="mw-headline">Diagnosis</span></h2> <div class="thumb tright"> <div class="thumbinner" style="width:202px;"><a href="/wiki/File:Peptic_stricture.png" class="image" title="Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach. This is a complication of chronic gastroesophageal reflux disease and can be a cause of dysphagia or difficulty swallowing"><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/1/16/Peptic_stricture.png/200px-Peptic_stricture.png" width="200" height="195" class="thumbimage" /></a> <div class="thumbcaption"> <div class="magnify"><a href="/wiki/File:Peptic_stricture.png" class="internal" title="Enlarge"><img src="/skins-1.5/common/images/magnify-clip.png" width="15" height="11" alt="" /></a></div> <a href="/wiki/Gastroscopy" title="Gastroscopy" class="mw-redirect">Endoscopic</a> image of peptic stricture, or narrowing of the <a href="/wiki/Esophagus" title="Esophagus">esophagus</a> near the junction with the <a href="/wiki/Stomach" title="Stomach">stomach</a>. This is a complication of chronic gastroesophageal reflux disease and can be a cause of <a href="/wiki/Dysphagia" title="Dysphagia">dysphagia</a> or difficulty swallowing</div> </div> </div> <p>A detailed historical knowledge is vital for an accurate diagnosis. Useful investigations may include <a href="/wiki/Barium" title="Barium">barium</a> swallow <a href="/wiki/X-ray" title="X-ray">X-rays</a>, <a href="/wiki/Esophageal_motility_study" title="Esophageal motility study">esophageal manometry</a>, 24 hour esophageal <a href="/wiki/Impedance-pH_monitoring" title="Impedance-pH monitoring">impedance-pH monitoring</a>, and <a href="/wiki/Esophagogastroduodenoscopy" title="Esophagogastroduodenoscopy">Esophagogastroduodenoscopy</a> (EGD). In general, an EGD is done when the patient either does not respond well to treatment or has alarm symptoms including <a href="/wiki/Dysphagia" title="Dysphagia">dysphagia</a>, anemia, blood in the stool (detected chemically), <a href="/wiki/Asthma" title="Asthma">wheezing</a>, weight loss, or voice changes. Some physicians advocate either once-in-a-lifetime or 5/10-yearly endoscopy for patients with longstanding GERD, to evaluate the possible presence of dysplasia or <a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a>, a precursor lesion for <a href="/wiki/Esophageal_cancer" title="Esophageal cancer">esophageal adenocarcinoma</a>.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span>[</span>7<span>]</span></a></sup></p> <p><a href="/wiki/Esophagogastroduodenoscopy" title="Esophagogastroduodenoscopy">Esophagogastroduodenoscopy</a> (EGD) (a form of <a href="/wiki/Endoscopy" title="Endoscopy">endoscopy</a>) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surfaces of the esophagus, stomach, and <a href="/wiki/Duodenum" title="Duodenum">duodenum</a>.</p> <p><a href="/wiki/Biopsy" title="Biopsy">Biopsies</a> can be performed during gastroscopy and these may show:</p> <ul> <li>Edema and basal hyperplasia (non-specific inflammatory changes)</li> <li>Lymphocytic inflammation (non-specific)</li> <li>Neutrophilic inflammation (usually due to reflux or <i><a href="/wiki/Helicobacter" title="Helicobacter">Helicobacter</a></i> <a href="/wiki/Gastritis" title="Gastritis">gastritis</a>)</li> <li>Eosinophilic inflammation (usually due to reflux)</li> <li>Goblet cell intestinal metaplasia or Barretts esophagus</li> <li>Elongation of the papillae</li> <li>Thinning of the squamous cell layer</li> <li><a href="/wiki/Dysplasia" title="Dysplasia">Dysplasia</a> or pre-cancer</li> <li><a href="/wiki/Carcinoma" title="Carcinoma">Carcinoma</a></li> </ul> <p>Reflux changes may be non-erosive in nature, leading to the entity "non-erosive reflux disease".</p> <p>Another test that has been used is the "Bernstein test".<sup id="cite_ref-pmid15056077_7-0" class="reference"><a href="#cite_note-pmid15056077-7"><span>[</span>8<span>]</span></a></sup></p> <p><a name="Pathophysiology" id="Pathophysiology"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=6" title="Edit section: Pathophysiology">edit</a>]</span> <span class="mw-headline">Pathophysiology</span></h2> <p>GERD is caused by a failure of the <a href="/wiki/Cardia" title="Cardia">cardia</a>. In healthy patients, the "Angle of His"—the angle at which the esophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue.</p> <p>Another paradoxical cause of GERD-like symptoms is not enough stomach acid (<a href="/wiki/Hypochlorhydria" title="Hypochlorhydria" class="mw-redirect">hypochlorhydria</a>). The valve that empties the stomach into the intestines is triggered by acidity. If there is not enough acid, this valve does not open, and the stomach contents are churned up into the esophagus. However, there is still enough acidity to irritate the esophagus.</p> <p>Factors that can contribute to GERD:</p> <ul> <li><a href="/wiki/Hiatal_hernia" title="Hiatal hernia" class="mw-redirect">Hiatal hernia</a>, which increases the likelihood of GERD due to mechanical and motility factors.<sup id="cite_ref-pmid17573791_8-0" class="reference"><a href="#cite_note-pmid17573791-8"><span>[</span>9<span>]</span></a></sup></li> <li><a href="/wiki/Obesity" title="Obesity">Obesity</a>: increasing <a href="/wiki/Body_mass_index" title="Body mass index">body mass index</a> is associated with more severe GERD.<sup id="cite_ref-pmid175737910_9-0" class="reference"><a href="#cite_note-pmid175737910-9"><span>[</span>10<span>]</span></a></sup></li> <li><a href="/wiki/Zollinger-Ellison_syndrome" title="Zollinger-Ellison syndrome">Zollinger-Ellison syndrome</a>, which can be present with increased gastric acidity due to <a href="/wiki/Gastrin" title="Gastrin">gastrin</a> production</li> <li><a href="/wiki/Hypercalcemia" title="Hypercalcemia" class="mw-redirect">Hypercalcemia</a>, which can increase <a href="/wiki/Gastrin" title="Gastrin">gastrin</a> production, leading to increased acidity</li> <li><a href="/wiki/Scleroderma" title="Scleroderma">Scleroderma</a> and <a href="/wiki/Systemic_sclerosis" title="Systemic sclerosis" class="mw-redirect">systemic sclerosis</a>, which can feature esophageal dysmotility</li> <li>The use of medicines such as <a href="/wiki/Prednisolone" title="Prednisolone">prednisolone</a></li> <li><a href="/wiki/Visceroptosis" title="Visceroptosis">Visceroptosis</a> or Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.</li> </ul> <p>GERD has been linked to <a href="/wiki/Laryngitis" title="Laryngitis">laryngitis</a>, chronic <a href="/wiki/Cough" title="Cough">cough</a>, <a href="/wiki/Pulmonary_fibrosis" title="Pulmonary fibrosis" class="mw-redirect">pulmonary fibrosis</a>, <a href="/wiki/Earache" title="Earache" class="mw-redirect">earache</a>, and <a href="/wiki/Asthma" title="Asthma">asthma</a>, even when not clinically apparent, as well as to <a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">laryngopharyngeal reflux</a> and ulcers of the <a href="/wiki/Vocal_cords" title="Vocal cords" class="mw-redirect">vocal cords</a>.</p> <p>Factors that have been linked with GERD but not conclusively:</p> <ul> <li><a href="/wiki/Sleep_apnea" title="Sleep apnea">Obstructive sleep apnea</a><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span>[</span>11<span>]</span></a></sup><sup id="cite_ref-pmid17198758_11-0" class="reference"><a href="#cite_note-pmid17198758-11"><span>[</span>12<span>]</span></a></sup></li> <li><a href="/wiki/Gallstones" title="Gallstones" class="mw-redirect">Gallstones</a>, which can impede the flow of <a href="/wiki/Bile" title="Bile">bile</a> into the <a href="/wiki/Duodenum" title="Duodenum">Duodenum</a>, which can affect the ability to neutralize <a href="/wiki/Gastric_acid" title="Gastric acid">gastric acid</a></li> </ul> <p>In 1999, a review of existing studies found that, on average, 40% of GERD patients also had <i><a href="/wiki/H._pylori" title="H. pylori" class="mw-redirect">H. pylori</a></i> infection.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span>[</span>13<span>]</span></a></sup> The eradication of <i>H. pylori</i> can lead to an increase in acid secretion,<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span>[</span>14<span>]</span></a></sup> leading to the question of whether <i>H. pylori</i>-infected GERD patients are any different than non-infected GERD patients. A <a href="/wiki/Double-blind" title="Double-blind" class="mw-redirect">double-blind</a> study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span>[</span>15<span>]</span></a></sup></p> <p><a name="Treatment" id="Treatment"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=7" title="Edit section: Treatment">edit</a>]</span> <span class="mw-headline">Treatment</span></h2> <p>Three classes of treatments exist for GERD. These include lifestyle modifications, medications, and surgery.</p> <p><a name="Lifestyle_modifications" id="Lifestyle_modifications"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=8" title="Edit section: Lifestyle modifications">edit</a>]</span> <span class="mw-headline">Lifestyle modifications</span></h3> <dl> <dt>Dietary modification</dt> </dl> <p>Certain foods and lifestyle are considered to promote gastroesophageal reflux, but a 2006 review suggested that evidence for most dietary interventions is anecdotal; only <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a> and elevating the head of the bed were supported by evidence.<sup id="cite_ref-pmid16682569_15-0" class="reference"><a href="#cite_note-pmid16682569-15"><span>[</span>16<span>]</span></a></sup> A subsequent randomized <a href="/wiki/Crossover_study" title="Crossover study">crossover study</a> showed benefit by avoiding eating two hours before bedtime.<sup id="cite_ref-pmid17573791_8-1" class="reference"><a href="#cite_note-pmid17573791-8"><span>[</span>9<span>]</span></a></sup></p> <ul> <li><a href="/wiki/Coffee" title="Coffee">Coffee</a>, <a href="/wiki/Alcoholic_beverage" title="Alcoholic beverage">alcohol</a>, and excessive amounts of <a href="/wiki/Vitamin_C" title="Vitamin C">Vitamin C</a> supplements stimulate gastric acid secretion. Taking these before bedtime especially can cause evening reflux.</li> <li><a href="/wiki/Antacids" title="Antacids" class="mw-redirect">Antacids</a> based on <a href="/wiki/Calcium_carbonate" title="Calcium carbonate">calcium carbonate</a> (but not <a href="/wiki/Aluminum_hydroxide" title="Aluminum hydroxide" class="mw-redirect">aluminum hydroxide</a>) were found to actually increase the acidity of the stomach. However, all antacids reduced acidity in the lower esophagus, so the net effect on GERD symptoms may still be positive.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span>[</span>17<span>]</span></a></sup></li> <li>Foods high in fats and <a href="/wiki/Tobacco_smoking" title="Tobacco smoking">smoking</a> reduce lower esophageal sphincter competence, so avoiding these may help. Fat also delays stomach emptying.</li> <li>Eating within 2–3 hours before bedtime.</li> <li>Large meals. Having smaller, more frequent meals reduces GERD risk, as it means there is less food in the stomach at any one time.</li> <li>Carbonated soft drinks with or without sugar.</li> <li><a href="/wiki/Chocolate" title="Chocolate">Chocolate</a> and <a href="/wiki/Peppermint" title="Peppermint">peppermint</a>.</li> <li><a href="/wiki/Acid" title="Acid">Acidic</a> foods: <a href="/wiki/Tomato" title="Tomato">tomatoes</a> and tomato-based preparations; <a href="/wiki/Citrus_fruits" title="Citrus fruits" class="mw-redirect">citrus fruits</a> and citrus juices.</li> <li><a href="/wiki/Cruciferous_vegetables" title="Cruciferous vegetables">Cruciferous vegetables</a>:cabbage, cauliflower, broccoli, and Brussels sprouts.</li> <li><a href="/wiki/Milk" title="Milk">Milk</a> and milk-based products containing calcium<sup class="noprint Template-Fact" title="This claim needs references to reliable sources from January 2009" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a></i>]</sup> and fat, within 2 hours of bedtime.</li> </ul> <dl> <dt>Positional therapy</dt> </dl> <p>Sleeping on the left side has been shown to reduce nighttime reflux episodes in patients.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span>[</span>18<span>]</span></a></sup></p> <p>A <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> suggested that elevating the head of bed is an effective therapy, although this conclusion was only supported by nonrandomized studies.<sup id="cite_ref-pmid16682569_15-1" class="reference"><a href="#cite_note-pmid16682569-15"><span>[</span>16<span>]</span></a></sup> The head of the bed can be elevated by plastic or wooden bed risers that support bed posts or legs, a therapeutic bed wedge pillow, or a wedge or an inflatable mattress lifter that fits in between mattress and box spring. The height of the elevation is critical and must be at least 6 to 8 inches (15 to 20 cm) to be at least minimally effective to prevent the backflow of gastric fluids. Some innerspring mattresses do not work well when inclined and may cause back pain; some prefer foam mattresses. Some practitioners use higher degrees of incline than provided by the commonly suggested 6 to 8 inches (15 to 20 cm) and claim greater success.</p> <p><a name="Medications" id="Medications"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=9" title="Edit section: Medications">edit</a>]</span> <span class="mw-headline">Medications</span></h3> <p>A number of drugs are approved to treat GERD, and are among the most-often-prescribed forms of <a href="/wiki/Medication" title="Medication" class="mw-redirect">medication</a> in most Western countries.</p> <ul> <li><a href="/wiki/Proton_pump_inhibitor" title="Proton pump inhibitor">Proton pump inhibitors</a> (such as <a href="/wiki/Omeprazole" title="Omeprazole">omeprazole</a>, <a href="/wiki/Pantoprazole" title="Pantoprazole">pantoprazole</a>, <a href="/wiki/Lansoprazole" title="Lansoprazole">lansoprazole</a>, and <a href="/wiki/Rabeprazole" title="Rabeprazole">rabeprazole</a>) are the most effective in reducing gastric acid secretion. These drugs stop acid secretion at the source of acid production, i.e., the proton pump.</li> <li>Gastric <a href="/wiki/H2_antagonist" title="H2 antagonist">H<sub>2</sub> receptor blockers</a> (such as <a href="/wiki/Ranitidine" title="Ranitidine">ranitidine</a>, <a href="/wiki/Famotidine" title="Famotidine">famotidine</a> and <a href="/wiki/Cimetidine" title="Cimetidine">cimetidine</a>) can reduce gastric secretion of acid. These drugs are technically <a href="/wiki/Antihistamine" title="Antihistamine" class="mw-redirect">antihistamines</a>. They relieve complaints in about 50% of all GERD patients. Compared to placebo (which also is associated with symptom improvement), they have a <a href="/wiki/Number_needed_to_treat" title="Number needed to treat">number needed to treat</a> of eight (8).<sup id="cite_ref-pmid17229239_18-0" class="reference"><a href="#cite_note-pmid17229239-18"><span>[</span>19<span>]</span></a></sup></li> <li><a href="/wiki/Antacid" title="Antacid">Antacids</a> before meals or symptomatically after symptoms begin can reduce gastric acidity (increase <a href="/wiki/PH" title="PH">pH</a>).</li> <li><a href="/wiki/Alginic_acid" title="Alginic acid">Alginic acid</a> (<a href="/wiki/Gaviscon" title="Gaviscon">Gaviscon</a>) may coat the mucosa as well as increase pH and decrease reflux. A <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> of <a href="/wiki/Randomized_controlled_trials" title="Randomized controlled trials" class="mw-redirect">randomized controlled trials</a> suggests <a href="/wiki/Alginic_acid" title="Alginic acid">alginic acid</a> may be the most effective of non-prescription treatments with a <a href="/wiki/Number_needed_to_treat" title="Number needed to treat">number needed to treat</a> of 4.<sup id="cite_ref-pmid17229239_18-1" class="reference"><a href="#cite_note-pmid17229239-18"><span>[</span>19<span>]</span></a></sup></li> <li><a href="/wiki/Prokinetic" title="Prokinetic" class="mw-redirect">Prokinetics</a> strengthen the lower esophageal sphincter (LES) and speed up gastric emptying. <a href="/wiki/Cisapride" title="Cisapride">Cisapride</a>, a member of this class, was withdrawn from the market for causing <a href="/wiki/Long_QT_syndrome" title="Long QT syndrome">Long QT syndrome</a> Reglan (metoclopramide) is a prokinetic with significant side effects called Tardive Dyskinesia/Dystonia. The United States Food and Drug Administration issued a Black Box Warning about Reglan in January 2009. A complete list of the symptoms of TD (plain English) are available at <sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span>[</span>20<span>]</span></a></sup></li> <li><a href="/wiki/Sucralfate" title="Sucralfate">Sucralfate</a> (Carafate) is also useful as an adjunct in helping to heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two (2) hours apart from meals and medications.</li> <li><a href="/wiki/Mosapride" title="Mosapride">Mosapride</a> citrate is a 5-HT4 receptor <a href="/wiki/Agonist" title="Agonist">agonist</a> used outside the United States largely as a therapy for GERD and <a href="/wiki/Dyspepsia" title="Dyspepsia">dyspepsia</a>.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span>[</span>21<span>]</span></a></sup></li> </ul> <p>Clinical trials which compare GERD treatments head-to-head provide physicians with critical information. Unfortunately most pharmaceutical-company sponsored studies are conducted versus placebo and not an active control. However, the DIAMOND has shown rough equivalence of efficacy between a "step-up" approach to therapy (antacids, followed by histamine antagonists, followed by PPIs) and a "step-down" approach (the reverse). The primary endpoint of the study was treatment success after 6 months, and was achieved for 70% of patients in "step-down" versus 72% of patients in "step-up".<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span>[</span>22<span>]</span></a></sup></p> <p><a name="Surgical_treatments" id="Surgical_treatments"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=10" title="Edit section: Surgical treatments">edit</a>]</span> <span class="mw-headline">Surgical treatments</span></h3> <p>The standard surgical treatment is the <i><a href="/wiki/Nissen_fundoplication" title="Nissen fundoplication">Nissen fundoplication</a></i>. In this procedure the upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done <a href="/wiki/Laparoscopic_surgery" title="Laparoscopic surgery">laparoscopically</a>.<sup id="cite_ref-Abbas_2004_22-0" class="reference"><a href="#cite_note-Abbas_2004-22"><span>[</span>23<span>]</span></a></sup> When compared to medical management laparoscopic fundoplication had better results at 1 year.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span>[</span>24<span>]</span></a></sup></p> <p>An obsolete treatment is <a href="/wiki/Vagotomy" title="Vagotomy">vagotomy</a> ("highly selective vagotomy"), the surgical removal of <a href="/wiki/Vagus_nerve" title="Vagus nerve">vagus nerve</a> branches that innervate the stomach lining. This treatment has been largely replaced by medication.</p> <p>Another treatment is transoral incisionless fundoplication (TIF) with the use of a device called Esophyx, which allows doctors to rebuild the valve between the stomach and the diaphragm by going through the esophagus.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span>[</span>25<span>]</span></a></sup></p> <p><a name="Other_treatments" id="Other_treatments"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=11" title="Edit section: Other treatments">edit</a>]</span> <span class="mw-headline">Other treatments</span></h3> <p>In 2000 the U.S. <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration" class="mw-redirect">Food and Drug Administration</a> (FDA) approved two <a href="/wiki/Endoscopy" title="Endoscopy">endoscopic</a> devices to treat chronic heartburn. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. However, long-term results were disappointing, and the device is no longer sold by Bard. Another, the <a href="/wiki/Stretta_procedure" title="Stretta procedure">Stretta Procedure</a>, uses electrodes to apply radio frequency energy to the LES. The long-term outcomes of both procedures compared to a Nissen fundoplication are still being determined.</p> <p>Subsequently the NDO Surgical Plicator was cleared by the FDA for endoscopic GERD treatment. The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture-based implant. The company ceased operations in mid 2008, and the device is no longer on the market.</p> <p>Another treatment that involved injection of a solution during endoscopy into the lower esophageal wall was available for about one year ending in late 2005. It was marketed under the name Enteryx. It was removed from the market due to several reports of complications from misplaced injections.</p> <p><a name="References" id="References"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=12" title="Edit section: References">edit</a>]</span> <span class="mw-headline">References</span></h2> <div class="references-small references-column-count references-column-count-2" style="-moz-column-count:2; column-count:2;"> <ol class="references"> <li id="cite_note-0"><b><a href="#cite_ref-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFDeVault_KR.2C_Castell_DO1999">DeVault KR, Castell DO (1999). "Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology". <i>Am. J. Gastroenterol.</i> <b>94</b> (6): 1434–42. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1572-0241.1999.1123_a.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1572-0241.1999.1123_a.x" rel="nofollow">10.1111/j.1572-0241.1999.1123_a.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10364004" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/10364004">PMID 10364004</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Updated+ guidelines+for+the+diagnosis+and+treatment+of+gastroesophageal+reflux+disease.+The+Practice+Parameters+Committee+of+the+America n+College+of+Gastroenterology&rft.jtitle=Am.+J.+Gastroenterol.&rft.aulast=DeVault+KR%2C+Castell+DO&rft.au=DeVault+K R%2C+Castell+DO&rft.date=1999&rft.volume=94&rft.issue=6&rft.pages=1434%E2%80%9342&rft_id=info:doi/10.1111%2 Fj.1572-0241.1999.1123_a.x&rft_id=info:pmid/10364004&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"> <span style="display: none;"> </span></span></li> <li id="cite_note-1"><b><a href="#cite_ref-1">^</a></b> <a href="http://www.healingdaily.com/conditions/saliva-ph-test.htm" class="external free" title="http://www.healingdaily.com/conditions/saliva-ph-test.htm" rel="nofollow">http://www.healingdaily.com/conditions/saliva-ph-test.htm</a></li> <li id="cite_note-Kahrilas-2">^ <a href="#cite_ref-Kahrilas_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Kahrilas_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Kahrilas_2-2"><sup><i><b>c</b></i></sup></a> <cite style="font-style:normal" class="" id="CITEREFKahrilas.2C_PJ2008">Kahrilas, PJ (2008). "<a href="http://content.nejm.org/cgi/content/short/359/16/1700" class="external text" title="http://content.nejm.org/cgi/content/short/359/16/1700" rel="nofollow">Gastroesophageal Reflux Disease</a>". <i>New England Journal of Medicine.</i> <b>359</b> (16): 1700–1707. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1056%2FNEJMcp0804684" class="external text" title="http://dx.doi.org/10.1056%2FNEJMcp0804684" rel="nofollow">10.1056/NEJMcp0804684</a></span><span class="printonly">. <a href="http://content.nejm.org/cgi/content/short/359/16/1700" class="external free" title="http://content.nejm.org/cgi/content/short/359/16/1700" rel="nofollow">http://content.nejm.org/cgi/content/short/359/16/1700</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Gastroes ophageal+Reflux+Disease&rft.jtitle=New+England+Journal+of+Medicine.&rft.aulast=Kahrilas%2C+PJ&rft.au=Kahrilas%2C+PJ &rft.date=2008&rft.volume=359&rft.issue=16&rft.pages=1700%E2%80%931707&rft_id=info:doi/10.1056%2FNEJMcp0804 684&rft_id=http%3A%2F%2Fcontent.nejm.org%2Fcgi%2Fcontent%2Fshort%2F359%2F16%2F1700&rfr_id=info:sid/en.wikipedia.org:Gas troesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-3"><b><a href="#cite_ref-3">^</a></b> <a href="http://healthlink.mcw.edu/article/968784529.html" class="external autonumber" title="http://healthlink.mcw.edu/article/968784529.html" rel="nofollow">[1]</a></li> <li id="cite_note-4"><b><a href="#cite_ref-4">^</a></b> <cite style="font-style:normal" class="web">"<a href="http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html" class="external text" title="http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html" rel="nofollow">Spitting Up in Babies</a>". familydoctor.org<span class="printonly">. <a href="http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html" class="external free" title="http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html" rel="nofollow">http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Spitting+U p+in+Babies&rft.atitle=&rft.pub=familydoctor.org&rft_id=http%3A%2F%2Ffamilydoctor.org%2Fonline%2Ffamdocen%2Fhome%2F children%2Fparents%2Finfants%2F218.html&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-5"><b><a href="#cite_ref-5">^</a></b> <a href="http://www.gerd-library.com/dysplasia-and-barretts-esophagus/Dysplasia" class="external text" title="http://www.gerd-library.com/dysplasia-and-barretts-esophagus/Dysplasia" rel="nofollow">and Barrett’s Esophagus</a>. Retrieved on 2009-02-01.</li> <li id="cite_note-6"><b><a href="#cite_ref-6">^</a></b> <a href="http://www.gerd-library.com/diagnosis-endoscopy/" class="external text" title="http://www.gerd-library.com/diagnosis-endoscopy/" rel="nofollow">Diagnosis - Endoscopy</a>. Retrieved on 2009-03-20.</li> <li id="cite_note-pmid15056077-7"><b><a href="#cite_ref-pmid15056077_7-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFJung_B.2C_Steinbach_J.2C_Beaumont_C.2C_Mittal_RK2004">Jung B, Steinbach J, Beaumont C, Mittal RK (March 2004). "<a href="http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x" class="external text" title="http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x" rel="nofollow">Lack of association between esophageal acid sensitivity detected by prolonged pH monitoring and Bernstein testing</a>". <i>Am. J. Gastroenterol.</i> <b>99</b> (3): 410–5. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1572-0241.2004.04089.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1572-0241.2004.04089.x" rel="nofollow">10.1111/j.1572-0241.2004.04089.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15056077" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/15056077">PMID 15056077</a><span class="printonly">. <a href="http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x" class="external free" title="http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x" rel="nofollow">http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Lack+of+ association+between+esophageal+acid+sensitivity+detected+by+prolonged+pH+monitoring+and+Bernstein+testing&rft.jtitle=Am.+J. +Gastroenterol.&rft.aulast=Jung+B%2C+Steinbach+J%2C+Beaumont+C%2C+Mittal+RK&rft.au=Jung+B%2C+Steinbach+J%2C+Beaumont+C% 2C+Mittal+RK&rft.date=March+2004&rft.volume=99&rft.issue=3&rft.pages=410%E2%80%935&rft_id=info:doi/10.1111% 2Fj.1572-0241.2004.04089.x&rft_id=info:pmid/15056077&rft_id=http%3A%2F%2Fdx.doi.org%2F10.1111%2Fj.1572-0241.2004.04089. x&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid17573791-8">^ <a href="#cite_ref-pmid17573791_8-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-pmid17573791_8-1"><sup><i><b>b</b></i></sup></a> <cite style="font-style:normal" class="" id="CITEREFPiesman_M.2C_Hwang_I.2C_Maydonovitch_C.2C_Wong_RK2007">Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". <i>Am. J. Gastroenterol.</i> <b>102</b> (10): 2128–2134. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1572-0241.2007.01348.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1572-0241.2007.01348.x" rel="nofollow">10.1111/j.1572-0241.2007.01348.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17573791" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/17573791">PMID 17573791</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Nocturna l+reflux+episodes+following+the+administration+of+a+standardized+meal.+Does+timing+matter%3F&rft.jtitle=Am.+J.+Gastroentero l.&rft.aulast=Piesman+M%2C+Hwang+I%2C+Maydonovitch+C%2C+Wong+RK&rft.au=Piesman+M%2C+Hwang+I%2C+Maydonovitch+C%2C+Wong+R K&rft.date=2007&rft.volume=102&rft.issue=10&rft.pages=2128%E2%80%932134&rft_id=info:doi/10.1111%2Fj.1572-02 41.2007.01348.x&rft_id=info:pmid/17573791&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid175737910-9"><b><a href="#cite_ref-pmid175737910_9-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFAyazi_S.2C_Crookes_P.2C_Peyre_C.2C2007">Ayazi S, Crookes P, Peyre C, (2007). "Objective documentation of the link between gastroesophageal reflux disease and obesity". <i>Am. J. Gastroenterol.</i> <b>102</b> (S): 138–139.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Objectiv e+documentation+of+the+link+between+gastroesophageal+reflux+disease+and+obesity&rft.jtitle=Am.+J.+Gastroenterol.&rft.au last=Ayazi+S%2C+Crookes+P%2C+Peyre+C%2C&rft.au=Ayazi+S%2C+Crookes+P%2C+Peyre+C%2C&rft.date=2007&rft.volume=102& rft.issue=S&rft.pages=138%E2%80%93139&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-10"><b><a href="#cite_ref-10">^</a></b> <cite style="font-style:normal" class="" id="CITEREFMorse_CA.2C_Quan_SF.2C_Mays_MZ.2C_Green_C.2C_Stephen_G.2C_Fass_R2004">Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R (2004). "Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?". <i>Clin. Gastroenterol. Hepatol.</i> <b>2</b> (9): 761–8. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1016%2FS1542-3565%2804%2900347-7" class="external text" title="http://dx.doi.org/10.1016%2FS1542-3565%2804%2900347-7" rel="nofollow">10.1016/S1542-3565(04)00347-7</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15354276" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/15354276">PMID 15354276</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Is+there +a+relationship+between+obstructive+sleep+apnea+and+gastroesophageal+reflux+disease%3F&rft.jtitle=Clin.+Gastroenterol.+Hepa tol.&rft.aulast=Morse+CA%2C+Quan+SF%2C+Mays+MZ%2C+Green+C%2C+Stephen+G%2C+Fass+R&rft.au=Morse+CA%2C+Quan+SF%2C+Mays+MZ% 2C+Green+C%2C+Stephen+G%2C+Fass+R&rft.date=2004&rft.volume=2&rft.issue=9&rft.pages=761%E2%80%938&rft_id=inf o:doi/10.1016%2FS1542-3565%2804%2900347-7&rft_id=info:pmid/15354276&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_r eflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid17198758-11"><b><a href="#cite_ref-pmid17198758_11-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFKasasbeh_A.2C_Kasasbeh_E.2C_Krishnaswamy_G2007">Kasasbeh A, Kasasbeh E, Krishnaswamy G (2007). "Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex—a hypothetical review". <i>Sleep Med Rev</i> <b>11</b> (1): 47–58. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1016%2Fj.smrv.2006.05.001" class="external text" title="http://dx.doi.org/10.1016%2Fj.smrv.2006.05.001" rel="nofollow">10.1016/j.smrv.2006.05.001</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17198758" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/17198758">PMID 17198758</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Potentia l+mechanisms+connecting+asthma%2C+esophageal+reflux%2C+and+obesity%2Fsleep+apnea+complex%26mdash%3Ba+hypothetical+review&rf t.jtitle=Sleep+Med+Rev&rft.aulast=Kasasbeh+A%2C+Kasasbeh+E%2C+Krishnaswamy+G&rft.au=Kasasbeh+A%2C+Kasasbeh+E%2C+Krishna swamy+G&rft.date=2007&rft.volume=11&rft.issue=1&rft.pages=47%E2%80%9358&rft_id=info:doi/10.1016%2Fj.smrv.20 06.05.001&rft_id=info:pmid/17198758&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-12"><b><a href="#cite_ref-12">^</a></b> <cite style="font-style:normal" class="" id="CITEREFH.J._O.27Connor1999">H.J. O'Connor (Feb 1999). "Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management". <i>Aliment Pharmacol Ther</i> <b>13</b> (2): 117-27. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1046%2Fj.1365-2036.1999.00460.x" class="external text" title="http://dx.doi.org/10.1046%2Fj.1365-2036.1999.00460.x" rel="nofollow">10.1046/j.1365-2036.1999.00460.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10102940" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/10102940">PMID 10102940</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Helicoba cter+pylori+and+gastro-oesophageal+reflux+disease-clinical+implications+and+management&rft.jtitle=Aliment+Pharmacol+Ther&am p;rft.aulast=H.J.+O%27Connor&rft.au=H.J.+O%27Connor&rft.date=Feb+1999&rft.volume=13&rft.issue=2&rft.pages=1 17-27&rft_id=info:doi/10.1046%2Fj.1365-2036.1999.00460.x&rft_id=info:pmid/10102940&rfr_id=info:sid/en.wikipedia.org :Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-13"><b><a href="#cite_ref-13">^</a></b> <cite style="font-style:normal" class="" id="CITEREFEl-Omar_E.2C_Oien_K.2C_Nujuni_AE.2C_et_al.1997">El-Omar E, Oien K, Nujuni AE, et al. (1997). "Helicobacter pylori infection and chronic gastric acid hyposecretion". <i>Gastroenterology</i> <b>113</b>: 15–24 opt=Abstract. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9207257" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/9207257">PMID 9207257</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Helicoba cter+pylori+infection+and+chronic+gastric+acid+hyposecretion&rft.jtitle=Gastroenterology&rft.aulast=El-Omar+E%2C+Oien+K %2C+Nujuni+AE%2C+et+al.&rft.au=El-Omar+E%2C+Oien+K%2C+Nujuni+AE%2C+et+al.&rft.date=1997&rft.volume=113&rft.page s=15%E2%80%9324+opt%3DAbstract&rft_id=info:pmid/9207257&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_diseas e"><span style="display: none;"> </span></span></li> <li id="cite_note-14"><b><a href="#cite_ref-14">^</a></b> <cite style="font-style:normal" class="" id="CITEREFC.A._Fallone.2C_A.N._Barkun.2C_S._Mayrand.2C_G._Wakil.2C_G._Friedman.2C_A._Szilagyi.2C_C._Wheeler_.26_D._Ross2004">C .A. Fallone, A.N. Barkun, S. Mayrand, G. Wakil, G. Friedman, A. Szilagyi, C. Wheeler & D. Ross (2004). "<a href="http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART" class="external text" title="http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART" rel="nofollow">There is no difference in the disease severity of gastro-oesophageal reflux disease between patients infected and not infected with Helicobacter pylori</a>". <i>Aliment Pharmacol Ther</i> <b>20</b> (7): 761-768. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1365-2036.2004.02171.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1365-2036.2004.02171.x" rel="nofollow">10.1111/j.1365-2036.2004.02171.x</a></span><span class="printonly">. <a href="http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART" class="external free" title="http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART" rel="nofollow">http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=There+is +no+difference+in+the+disease+severity+of+gastro-oesophageal+reflux+disease+between+patients+infected+and+not+infected+with+Hel icobacter+pylori&rft.jtitle=Aliment+Pharmacol+Ther&rft.aulast=C.A.+Fallone%2C+A.N.+Barkun%2C+S.+Mayrand%2C+G.+Wakil%2C+ G.+Friedman%2C+A.+Szilagyi%2C+C.+Wheeler+%26+D.+Ross&rft.au=C.A.+Fallone%2C+A.N.+Barkun%2C+S.+Mayrand%2C+G.+Wakil%2C+G.+Fri edman%2C+A.+Szilagyi%2C+C.+Wheeler+%26+D.+Ross&rft.date=2004&rft.volume=20&rft.issue=7&rft.pages=761-768&rf t_id=info:doi/10.1111%2Fj.1365-2036.2004.02171.x&rft_id=http%3A%2F%2Fwww3.interscience.wiley.com%2Fcgi-bin%2Ffulltext%2F118 774431%2FHTMLSTART&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid16682569-15">^ <a href="#cite_ref-pmid16682569_15-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-pmid16682569_15-1"><sup><i><b>b</b></i></sup></a> <cite style="font-style:normal" class="" id="CITEREFKaltenbach_T.2C_Crockett_S.2C_Gerson_LB2006">Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". <i>Arch. Intern. Med.</i> <b>166</b> (9): 965–71. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1001%2Farchinte.166.9.965" class="external text" title="http://dx.doi.org/10.1001%2Farchinte.166.9.965" rel="nofollow">10.1001/archinte.166.9.965</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16682569" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/16682569">PMID 16682569</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Are+life style+measures+effective+in+patients+with+gastroesophageal+reflux+disease%3F+An+evidence-based+approach&rft.jtitle=Arch.+In tern.+Med.&rft.aulast=Kaltenbach+T%2C+Crockett+S%2C+Gerson+LB&rft.au=Kaltenbach+T%2C+Crockett+S%2C+Gerson+LB&rft.da te=2006&rft.volume=166&rft.issue=9&rft.pages=965%E2%80%9371&rft_id=info:doi/10.1001%2Farchinte.166.9.965&rf t_id=info:pmid/16682569&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-16"><b><a href="#cite_ref-16">^</a></b> <cite style="font-style:normal" class="" id="CITEREFDecktor_DL.2C_Robinson_M.2C_Maton_PN.2C_Lanza_FL.2C_Gottlieb_S1995">Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S (1995). "Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn". <i>Am J Ther</i> <b>2</b> (8): 546–552. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1097%2F00045391-199508000-00006" class="external text" title="http://dx.doi.org/10.1097%2F00045391-199508000-00006" rel="nofollow">10.1097/00045391-199508000-00006</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11854825" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/11854825">PMID 11854825</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Effects+ of+Aluminum%2FMagnesium+Hydroxide+and+Calcium+Carbonate+on+Esophageal+and+Gastric+pH+in+Subjects+with+Heartburn&rft.jtitle= Am+J+Ther&rft.aulast=Decktor+DL%2C+Robinson+M%2C+Maton+PN%2C+Lanza+FL%2C+Gottlieb+S&rft.au=Decktor+DL%2C+Robinson+M%2C+ Maton+PN%2C+Lanza+FL%2C+Gottlieb+S&rft.date=1995&rft.volume=2&rft.issue=8&rft.pages=546%E2%80%93552&rft_id= info:doi/10.1097%2F00045391-199508000-00006&rft_id=info:pmid/11854825&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal _reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-17"><b><a href="#cite_ref-17">^</a></b> <cite style="font-style:normal" class="" id="CITEREFKhouryCamacho-Lobato_L.2C_Katz_PO.2C_Mohiuddin_MA.2C_Castell_DO1999">Khoury, RM; Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO (1999). "Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease". <i>Am. J. Gastroenterol.</i> <b>94</b> (8): 2069–73. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1572-0241.1999.01279.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1572-0241.1999.01279.x" rel="nofollow">10.1111/j.1572-0241.1999.01279.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10445529" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/10445529">PMID 10445529</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Influenc e+of+spontaneous+sleep+positions+on+nighttime+recumbent+reflux+in+patients+with+gastroesophageal+reflux+disease&rft.jtitle= Am.+J.+Gastroenterol.&rft.aulast=Khoury&rft.aufirst=RM&rft.au=Khoury%2C+RM&rft.au=Camacho-Lobato+L%2C+Katz+PO%2 C+Mohiuddin+MA%2C+Castell+DO&rft.date=1999&rft.volume=94&rft.issue=8&rft.pages=2069%E2%80%9373&rft_id=info: doi/10.1111%2Fj.1572-0241.1999.01279.x&rft_id=info:pmid/10445529&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_refl ux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid17229239-18">^ <a href="#cite_ref-pmid17229239_18-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-pmid17229239_18-1"><sup><i><b>b</b></i></sup></a> <cite style="font-style:normal" class="" id="CITEREFTran_T.2C_Lowry_A.2C_El-Serag_H2007">Tran T, Lowry A, El-Serag H (2007). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs". <i>Aliment Pharmacol Ther</i> <b>25</b> (2): 143–53. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1365-2036.2006.03135.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1365-2036.2006.03135.x" rel="nofollow">10.1111/j.1365-2036.2006.03135.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17229239" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/17229239">PMID 17229239</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Meta-ana lysis%3A+the+efficacy+of+over-the-counter+gastro-oesophageal+reflux+disease+drugs&rft.jtitle=Aliment+Pharmacol+Ther&rft .aulast=Tran+T%2C+Lowry+A%2C+El-Serag+H&rft.au=Tran+T%2C+Lowry+A%2C+El-Serag+H&rft.date=2007&rft.volume=25&rft. issue=2&rft.pages=143%E2%80%9353&rft_id=info:doi/10.1111%2Fj.1365-2036.2006.03135.x&rft_id=info:pmid/17229239&r fr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-19"><b><a href="#cite_ref-19">^</a></b> <a href="http://www.reflux.org/reflux/webdoc01.nsf/487b3ba0c2f1a4ff85256ff30009f061/6472ef5bda1863778525703b005b9c3e/$FILE/Tardive %20PGMay04Article.pdf" class="external free" title="http://www.reflux.org/reflux/webdoc01.nsf/487b3ba0c2f1a4ff85256ff30009f061/6472ef5bda1863778525703b005b9c3e/$FILE/Tardiv e%20PGMay04Article.pdf" rel="nofollow">http://www.reflux.org/reflux/webdoc01.nsf/487b3ba0c2f1a4ff85256ff30009f061/6472ef5bda1863778525703b005b9c3e/$FIL E/Tardive%20PGMay04Article.pdf</a></li> <li id="cite_note-20"><b><a href="#cite_ref-20">^</a></b> <cite style="font-style:normal" class="web">"<a href="http://www.medscape.com/viewarticle/518324_4" class="external text" title="http://www.medscape.com/viewarticle/518324_4" rel="nofollow">www.medscape.com</a>"<span class="printonly">. <a href="http://www.medscape.com/viewarticle/518324_4" class="external free" title="http://www.medscape.com/viewarticle/518324_4" rel="nofollow">http://www.medscape.com/viewarticle/518324_4</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=www.medsca pe.com&rft.atitle=&rft_id=http%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F518324_4&rfr_id=info:sid/en.wikipedia.org:G astroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-21"><b><a href="#cite_ref-21">^</a></b> <cite style="font-style:normal" class="" id="CITEREFvan_Marrewjik_et_al.2009">van Marrewjik et al. (2009). "Effect and cost-effectiveness of step-up versus step-down treatment with antacids, H2-receptor antagonists, and proton pump inhibitors in patients with new onset dyspepsia (DIAMOND study): a primary-care-based randomized controlled study". <i>The Lancet</i> <b>373</b>: 215–25. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1016%2FS0140-6736%2809%2960070-2" class="external text" title="http://dx.doi.org/10.1016%2FS0140-6736%2809%2960070-2" rel="nofollow">10.1016/S0140-6736(09)60070-2</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Effect+a nd+cost-effectiveness+of+step-up+versus+step-down+treatment+with+antacids%2C+H2-receptor+antagonists%2C+and+proton+pump+inhibit ors+in+patients+with+new+onset+dyspepsia+%28DIAMOND+study%29%3A+a+primary-care-based+randomized+controlled+study&rft.jtitle =The+Lancet&rft.aulast=van+Marrewjik+et+al.&rft.au=van+Marrewjik+et+al.&rft.date=2009&rft.volume=373&rft.pa ges=215%E2%80%9325&rft_id=info:doi/10.1016%2FS0140-6736%2809%2960070-2&rfr_id=info:sid/en.wikipedia.org:Gastroesophagea l_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-Abbas_2004-22"><b><a href="#cite_ref-Abbas_2004_22-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFAbbas_A.2C_Deschamps_C.2C_Cassivi_SD.2C_et_al.2004">Abbas A, Deschamps C, Cassivi SD, et al. (2004). "The role of laparoscopic fundoplication in Barrett’s esophagus". <i>Annals of Thoracic Surgery</i> <b>77</b> (2): 393–396. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1016%2FS0003-4975%2803%2901352-3" class="external text" title="http://dx.doi.org/10.1016%2FS0003-4975%2803%2901352-3" rel="nofollow">10.1016/S0003-4975(03)01352-3</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14759403" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/14759403">PMID 14759403</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+role +of+laparoscopic+fundoplication+in+Barrett%E2%80%99s+esophagus&rft.jtitle=Annals+of+Thoracic+Surgery&rft.aulast=Abbas+A %2C+Deschamps+C%2C+Cassivi+SD%2C+et+al.&rft.au=Abbas+A%2C+Deschamps+C%2C+Cassivi+SD%2C+et+al.&rft.date=2004&rft.vol ume=77&rft.issue=2&rft.pages=393%E2%80%93396&rft_id=info:doi/10.1016%2FS0003-4975%2803%2901352-3&rft_id=info:pm id/14759403&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-23"><b><a href="#cite_ref-23">^</a></b> <cite style="font-style:normal" class="" id="CITEREFGrant_AM.2C_Wileman_SM.2C_Ramsay_CR.2C_.27.27et_al..27.272008">Grant AM, Wileman SM, Ramsay CR, <i>et al.</i> (2008). "<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2603580" class="external text" title="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2603580" rel="nofollow">Minimal access surgery compared with medical management for chronic gastro-oesophageal reflux disease: UK collaborative randomised trial</a>". <i>BMJ</i> <b>337</b>: a2664. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19074946" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/19074946">PMID 19074946</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Minimal+ access+surgery+compared+with+medical+management+for+chronic+gastro-oesophageal+reflux+disease%3A+UK+collaborative+randomised+tr ial&rft.jtitle=BMJ&rft.aulast=Grant+AM%2C+Wileman+SM%2C+Ramsay+CR%2C+%27%27et+al.%27%27&rft.au=Grant+AM%2C+Wileman+ SM%2C+Ramsay+CR%2C+%27%27et+al.%27%27&rft.date=2008&rft.volume=337&rft.pages=a2664&rft_id=info:pmid/19074946&am p;rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-24"><b><a href="#cite_ref-24">^</a></b> <a href="http://www.cbsnews.com/stories/2009/01/16/health/main4728359.shtml?source=RSSattr=Health_4728359" class="external text" title="http://www.cbsnews.com/stories/2009/01/16/health/main4728359.shtml?source=RSSattr=Health_4728359" rel="nofollow">New Surgery For Acid Reflux Sufferers</a>. Retrieved on 2009-01-16.</li> </ol> </div> <p><a name="External_links" id="External_links"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=13" title="Edit section: External links">edit</a>]</span> <span class="mw-headline">External links</span></h2> <ul> <li><a href="http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/" class="external text" title="http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/" rel="nofollow">GERD patient information page</a> at <a href="/wiki/NIH" title="NIH" class="mw-redirect">NIH</a></li> <li><a href="http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/acidpeptic/acidpeptic.htm" class="external text" title="http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/acidpeptic/acidpeptic.htm" rel="nofollow">Overview</a> of acid peptic disorders from the Cleveland Clinic.</li> </ul> <table class="navbox" cellspacing="0" style=";"> <tr> <td style="padding:2px;"> <table cellspacing="0" class="nowraplinks collapsible collapsed" style="width:100%;background:transparent;color:inherit;;"> <tr> <th style=";background:silver;" colspan="2" class="navbox-title"> <div style="float:left; width:6em;text-align:left;"> <div class="noprint plainlinks navbar" style="background:none; padding:0; font-weight:normal;;background:silver;;border:none;; font-size:xx-small;"><a href="/wiki/Template:Digestive_system_diseases" title="Template:Digestive system diseases"><span title="View this template" style=";background:silver;;border:none;">v</span></a> <span style="font-size:80%;">•</span> <a href="/wiki/Template_talk:Digestive_system_diseases" title="Template talk:Digestive system diseases"><span title="Discuss this template" style=";background:silver;;border:none;">d</span></a> <span style="font-size:80%;">•</span> <a href="http://en.wikipedia.org/w/index.php?title=Template:Digestive_system_diseases&action=edit" class="external text" title="http://en.wikipedia.org/w/index.php?title=Template:Digestive_system_diseases&action=edit" rel="nofollow"><span title="Edit this template" style=";background:silver;;border:none;;">e</span></a></div> </div> <span class="" style="font-size:110%;"><a href="/wiki/Digestive_system" title="Digestive system" class="mw-redirect">Digestive system</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Digestive_disease" title="Digestive disease">Digestive disease</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a> (primarily <a href="/wiki/ICD-10_Chapter_XI:_Diseases_of_the_digestive_system" title="ICD-10 Chapter XI: Diseases of the digestive system">K20-K93</a>, <a href="/wiki/List_of_ICD-9_codes_520-579:_Diseases_of_the_digestive_system#diseases_of_esophagus.2C_stomach.2C_and_duodenum_.285 30-537.29" title="List of ICD-9 codes 520-579: Diseases of the digestive system" class="mw-redirect">530-579</a>)</span></th> </tr> <tr style="height:2px;"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Upper_alimentary_tract#Upper_gastrointestinal_tract" title="Upper alimentary tract" class="mw-redirect">Upper GI tract</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"></div> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Esophageal_disease" title="Esophageal disease">Esophagus</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Esophagitis" title="Esophagitis">Esophagitis</a> (<a href="/wiki/Esophageal_candidiasis" title="Esophageal candidiasis">Candidal</a>)<span style="font-weight:bold;"> ·</span> <i>rupture</i> (<a href="/wiki/Boerhaave_syndrome" title="Boerhaave syndrome">Boerhaave syndrome</a>, <a href="/wiki/Mallory-Weiss_syndrome" title="Mallory-Weiss syndrome">Mallory-Weiss syndrome</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Upper_esophageal_sphincter" title="Upper esophageal sphincter">UES</a> (<a href="/wiki/Zenker%27s_diverticulum" title="Zenker's diverticulum">Zenker's diverticulum</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Lower_esophageal_sphincter" title="Lower esophageal sphincter" class="mw-redirect">LES</a> (<a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Esophageal_motility_disorder" title="Esophageal motility disorder">Esophageal motility disorder</a> (<a href="/wiki/Nutcracker_esophagus" title="Nutcracker esophagus">Nutcracker esophagus</a>, <a href="/wiki/Achalasia" title="Achalasia">Achalasia</a>, <a href="/wiki/Diffuse_esophageal_spasm" title="Diffuse esophageal spasm">Diffuse esophageal spasm</a>, <strong class="selflink">GERD</strong>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Esophageal_stricture" title="Esophageal stricture">Esophageal stricture</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Megaesophagus" title="Megaesophagus">Megaesophagus</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Stomach_disease" title="Stomach disease">Stomach</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Gastritis" title="Gastritis">Gastritis</a> (<a href="/wiki/Atrophic_gastritis" title="Atrophic gastritis">Atrophic</a>, <a href="/wiki/M%C3%A9n%C3%A9trier%27s_disease" title="Ménétrier's disease">Ménétrier's disease</a>, <a href="/wiki/Gastroenteritis" title="Gastroenteritis">Gastroenteritis</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Peptic_ulcer" title="Peptic ulcer">Peptic (gastric) ulcer</a> (<a href="/wiki/Cushing_ulcer" title="Cushing ulcer">Cushing ulcer</a>, <a href="/wiki/Dieulafoy%27s_lesion" title="Dieulafoy's lesion">Dieulafoy's lesion</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Dyspepsia" title="Dyspepsia">Dyspepsia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Pyloric_stenosis" title="Pyloric stenosis">Pyloric stenosis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Achlorhydria" title="Achlorhydria">Achlorhydria</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastroparesis" title="Gastroparesis">Gastroparesis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastroptosis" title="Gastroptosis">Gastroptosis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Portal_hypertensive_gastropathy" title="Portal hypertensive gastropathy">Portal hypertensive gastropathy</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastric_antral_vascular_ectasia" title="Gastric antral vascular ectasia">Gastric antral vascular ectasia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastric_dumping_syndrome" title="Gastric dumping syndrome">Gastric dumping syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastric_volvulus" title="Gastric volvulus">Gastric volvulus</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Intestinal_disease" title="Intestinal disease" class="mw-redirect">Intestinal</a>/<br /> <a href="/wiki/Enteropathy" title="Enteropathy">enteropathy</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"></div> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Small_intestine" title="Small intestine">Small intestine</a>/<br /> (<a href="/wiki/Duodenum" title="Duodenum">duodenum</a>/<a href="/wiki/Jejunum" title="Jejunum">jejunum</a>/<a href="/wiki/Ileum" title="Ileum">ileum</a>)</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Enteritis" title="Enteritis">Enteritis</a> (<a href="/wiki/Duodenitis" title="Duodenitis">Duodenitis</a>, <a href="/wiki/Jejunitis" title="Jejunitis" class="mw-redirect">Jejunitis</a>, <a href="/wiki/Ileitis" title="Ileitis">Ileitis</a>) — <a href="/wiki/Peptic_ulcer" title="Peptic ulcer">Peptic (duodenal) ulcer</a> (<a href="/wiki/Curling%27s_ulcer" title="Curling's ulcer">Curling's ulcer</a>) — <a href="/wiki/Malabsorption" title="Malabsorption">Malabsorption</a>: <a href="/wiki/Coeliac_disease" title="Coeliac disease">Coeliac</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Tropical_sprue" title="Tropical sprue">Tropical sprue</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Blind_loop_syndrome" title="Blind loop syndrome">Blind loop syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Whipple%27s_disease" title="Whipple's disease">Whipple's</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Short_bowel_syndrome" title="Short bowel syndrome">Short bowel syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Steatorrhea" title="Steatorrhea">Steatorrhea</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Milroy_disease" title="Milroy disease" class="mw-redirect">Milroy disease</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Large_intestine" title="Large intestine">Large intestine</a><br /> (<a href="/wiki/Vermiform_appendix" title="Vermiform appendix">appendix</a>/<a href="/wiki/Colon_(anatomy)" title="Colon (anatomy)">colon</a>)</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Appendicitis" title="Appendicitis">Appendicitis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Colitis" title="Colitis">Colitis</a> (<a href="/wiki/Pseudomembranous_colitis" title="Pseudomembranous colitis">Pseudomembranous</a>, <a href="/wiki/Ulcerative_colitis" title="Ulcerative colitis">Ulcerative</a>, <a href="/wiki/Ischemic_colitis" title="Ischemic colitis">Ischemic</a>, <a href="/wiki/Microscopic_colitis" title="Microscopic colitis">Microscopic</a>, <a href="/wiki/Collagenous_colitis" title="Collagenous colitis">Collagenous</a>, <a href="/wiki/Lymphocytic_colitis" title="Lymphocytic colitis">Lymphocytic</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Functional_colonic_disease" title="Functional colonic disease">Functional colonic disease</a> (<a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">IBS</a>, <a href="/wiki/Intestinal_pseudoobstruction" title="Intestinal pseudoobstruction">Intestinal pseudoobstruction</a>/<a href="/wiki/Ogilvie_syndrome" title="Ogilvie syndrome">Ogilvie syndrome</a>) — <a href="/wiki/Megacolon" title="Megacolon">Megacolon</a>/<a href="/wiki/Toxic_megacolon" title="Toxic megacolon">Toxic megacolon</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Diverticulitis" title="Diverticulitis">Diverticulitis</a>/<a href="/wiki/Diverticulosis" title="Diverticulosis">Diverticulosis</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;">Large and/or small</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Enterocolitis" title="Enterocolitis">Enterocolitis</a> (<a href="/wiki/Necrotizing_enterocolitis" title="Necrotizing enterocolitis">Necrotizing</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">IBD</a> (<a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a>) — <i><a href="/wiki/Vascular_disease" title="Vascular disease">vascular</a></i>: <a href="/wiki/Abdominal_angina" title="Abdominal angina">Abdominal angina</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Mesenteric_ischemia" title="Mesenteric ischemia">Mesenteric ischemia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Angiodysplasia" title="Angiodysplasia">Angiodysplasia</a> — <a href="/wiki/Bowel_obstruction" title="Bowel obstruction">Bowel obstruction</a>: <a href="/wiki/Ileus" title="Ileus">Ileus</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Intussusception_(medical_disorder)" title="Intussusception (medical disorder)">Intussusception</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Volvulus" title="Volvulus">Volvulus</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Fecal_impaction" title="Fecal impaction">Fecal impaction</a> — <a href="/wiki/Constipation" title="Constipation">Constipation</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Diarrhea" title="Diarrhea">Diarrhea</a> (<a href="/wiki/Infectious_diarrhea" title="Infectious diarrhea">Infectious</a>)</div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Rectum" title="Rectum">Rectum</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Proctitis" title="Proctitis">Proctitis</a> (<a href="/wiki/Radiation_proctitis" title="Radiation proctitis">Radiation proctitis</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Proctalgia_fugax" title="Proctalgia fugax">Proctalgia fugax</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Rectal_prolapse" title="Rectal prolapse">Rectal prolapse</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Human_anus" title="Human anus">Anus</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Anal_fissure" title="Anal fissure">Anal fissure</a>/<a href="/wiki/Anal_fistula" title="Anal fistula">Anal fistula</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Anal_abscess" title="Anal abscess">Anal abscess</a> <span style="font-weight:bold;"> ·</span> <a href="/wiki/Anal_dysplasia" title="Anal dysplasia">Anal dysplasia</a> <span style="font-weight:bold;"> ·</span> <a href="/wiki/Pruritus_ani" title="Pruritus ani">Pruritus ani</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Accessory_digestive_gland" title="Accessory digestive gland">Accessory</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"></div> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Liver_disease" title="Liver disease">Liver</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Hepatitis" title="Hepatitis">Hepatitis</a> (<a href="/wiki/Viral_hepatitis" title="Viral hepatitis">Viral hepatitis</a>, <a href="/wiki/Autoimmune_hepatitis" title="Autoimmune hepatitis">Autoimmune hepatitis</a>, <a href="/wiki/Alcoholic_hepatitis" title="Alcoholic hepatitis">Alcoholic hepatitis</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Cirrhosis" title="Cirrhosis">Cirrhosis</a> (<a href="/wiki/Primary_biliary_cirrhosis" title="Primary biliary cirrhosis">PBC</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Fatty_liver" title="Fatty liver">Fatty liver</a> (<a href="/wiki/Non-alcoholic_fatty_liver_disease" title="Non-alcoholic fatty liver disease">NASH</a>)<span style="font-weight:bold;"> ·</span> <i><a href="/wiki/Vascular_disease" title="Vascular disease">vascular</a></i> (<a href="/wiki/Hepatic_veno-occlusive_disease" title="Hepatic veno-occlusive disease">Hepatic veno-occlusive disease</a>, <a href="/wiki/Portal_hypertension" title="Portal hypertension">Portal hypertension</a>, <a href="/wiki/Nutmeg_liver" title="Nutmeg liver">Nutmeg liver</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Alcoholic_liver_disease" title="Alcoholic liver disease">Alcoholic liver disease</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Liver_failure" title="Liver failure">Liver failure</a> (<a href="/wiki/Hepatic_encephalopathy" title="Hepatic encephalopathy">Hepatic encephalopathy</a>, <a href="/wiki/Acute_liver_failure" title="Acute liver failure">Acute liver failure</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Liver_abscess" title="Liver abscess">Liver abscess</a> (<a href="/wiki/Pyogenic_liver_abscess" title="Pyogenic liver abscess">Pyogenic</a>, <a href="/wiki/Amoebic_liver_abscess" title="Amoebic liver abscess">Amoebic</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Hepatorenal_syndrome" title="Hepatorenal syndrome">Hepatorenal syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Peliosis_hepatis" title="Peliosis hepatis">Peliosis hepatis</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Gallbladder_disease" title="Gallbladder disease" class="mw-redirect">Gallbladder</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Cholecystitis" title="Cholecystitis">Cholecystitis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gallstone" title="Gallstone">Gallstones</a>/<a href="/wiki/Cholecystolithiasis" title="Cholecystolithiasis" class="mw-redirect">Cholecystolithiasis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Cholesterolosis_of_gallbladder" title="Cholesterolosis of gallbladder">Cholesterolosis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Rokitansky-Aschoff_sinuses" title="Rokitansky-Aschoff sinuses">Rokitansky-Aschoff sinuses</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Postcholecystectomy_syndrome" title="Postcholecystectomy syndrome">Postcholecystectomy syndrome</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Bile_duct" title="Bile duct">Bile duct</a>/<br /> other <a href="/wiki/Biliary_tree" title="Biliary tree" class="mw-redirect">biliary tree</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Cholangitis" title="Cholangitis">Cholangitis</a> (<a href="/wiki/Primary_sclerosing_cholangitis" title="Primary sclerosing cholangitis">PSC</a>, <a href="/wiki/Secondary_sclerosing_cholangitis" title="Secondary sclerosing cholangitis">Secondary sclerosing cholangitis</a>, <a href="/wiki/Ascending_cholangitis" title="Ascending cholangitis">Ascending</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Cholestasis" title="Cholestasis">Cholestasis</a>/<a href="/wiki/Mirizzi%27s_syndrome" title="Mirizzi's syndrome">Mirizzi's syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Biliary_fistula" title="Biliary fistula">Biliary fistula</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Haemobilia" title="Haemobilia">Haemobilia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gallstone" title="Gallstone">Gallstones</a>/<a href="/wiki/Cholelithiasis" title="Cholelithiasis" class="mw-redirect">Cholelithiasis</a><br /> <i><a href="/wiki/Common_bile_duct" title="Common bile duct">common bile duct</a></i> (<a href="/wiki/Choledocholithiasis" title="Choledocholithiasis">Choledocholithiasis</a>, <a href="/wiki/Biliary_dyskinesia" title="Biliary dyskinesia">Biliary dyskinesia</a>)</div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Pancreatic_disease" title="Pancreatic disease">Pancreatic</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Pancreatitis" title="Pancreatitis">Pancreatitis</a> (<a href="/wiki/Acute_pancreatitis" title="Acute pancreatitis">Acute</a>, <a href="/wiki/Chronic_pancreatitis" title="Chronic pancreatitis">Chronic</a>, <a href="/wiki/Hereditary_pancreatitis" title="Hereditary pancreatitis">Hereditary</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Pancreatic_pseudocyst" title="Pancreatic pseudocyst">Pancreatic pseudocyst</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Exocrine_pancreatic_insufficiency" title="Exocrine pancreatic insufficiency">Exocrine pancreatic insufficiency</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Pancreatic_fistula" title="Pancreatic fistula">Pancreatic fistula</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Hernia" title="Hernia">Hernia</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Diaphragmatic_hernia" title="Diaphragmatic hernia">Diaphragmatic</a>: <a href="/wiki/Congenital_diaphragmatic_hernia" title="Congenital diaphragmatic hernia">Congenital diaphragmatic</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Hiatus_hernia" title="Hiatus hernia">Hiatus</a> — <a href="/wiki/Abdominal_hernia" title="Abdominal hernia" class="mw-redirect">Abdominal hernia</a>: <a href="/wiki/Inguinal_hernia" title="Inguinal hernia">Inguinal</a> (<a href="/wiki/Indirect_inguinal_hernia" title="Indirect inguinal hernia">Indirect</a>, <a href="/wiki/Direct_inguinal_hernia" title="Direct inguinal hernia">Direct</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Umbilical_hernia" title="Umbilical hernia">Umbilical</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Incisional_hernia" title="Incisional hernia">Incisional</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Femoral_hernia" title="Femoral hernia">Femoral</a> — <a href="/wiki/Obturator_hernia" title="Obturator hernia">Obturator hernia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Spigelian_hernia" title="Spigelian hernia">Spigelian hernia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Internal_hernia" title="Internal hernia">Internal hernia</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Peritoneal_disease" title="Peritoneal disease" class="mw-redirect">Peritoneal</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Peritonitis" title="Peritonitis">Peritonitis</a> (<a href="/wiki/Spontaneous_bacterial_peritonitis" title="Spontaneous bacterial peritonitis">Spontaneous bacterial peritonitis</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Hemoperitoneum" title="Hemoperitoneum">Hemoperitoneum</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Pneumoperitoneum" title="Pneumoperitoneum">Pneumoperitoneum</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Gastrointestinal_bleeding" title="Gastrointestinal bleeding">GI bleeding</a>/<a href="/wiki/Blood_in_stool" title="Blood in stool">BIS</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Upper_gastrointestinal_bleeding" title="Upper gastrointestinal bleeding">Upper</a> (<a href="/wiki/Hematemesis" title="Hematemesis">Hematemesis</a>, <a href="/wiki/Melena" title="Melena">Melena</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Lower_gastrointestinal_bleeding" title="Lower gastrointestinal bleeding">Lower</a> (<a href="/wiki/Hematochezia" title="Hematochezia">Hematochezia</a>)</div> </td> </tr> <tr style="height:2px;"> <td></td> </tr> <tr> <td class="navbox-abovebelow" style=";" colspan="2"> <div class="rellink boilerplate seealso">See also: <a href="/wiki/Template:Congenital_malformations_and_deformations_of_digestive_system" title="Template:Congenital malformations and deformations of digestive system">congenital</a> and <a href="/wiki/Template:Digestive_system_neoplasia" title="Template:Digestive system neoplasia">neoplasia</a></div> </td> </tr> </table> </td> </tr> </table>   <div class="printfooter"> Retrieved from "<a href="http://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease">http://en.wikipedia.org/wiki/Gastroesophageal_reflux_diseas e</a>"</div> <div id='catlinks' class='catlinks'><div id="mw-normal-catlinks"><a href="/wiki/Special:Categories" title="Special:Categories">Categories</a>: <span dir='ltr'><a href="/wiki/Category:Digestive_diseases" title="Category:Digestive diseases">Digestive diseases</a></span> | <span dir='ltr'><a href="/wiki/Category:General_practice" title="Category:General practice">General practice</a></span> | <span dir='ltr'><a href="/wiki/Category:Medical_conditions_related_to_obesity" title="Category:Medical conditions related to obesity">Medical conditions related to obesity</a></span></div><div id="mw-hidden-catlinks" class="mw-hidden-cats-hidden">Hidden categories: <span dir='ltr'><a href="/wiki/Category:All_articles_with_unsourced_statements" title="Category:All articles with unsourced statements">All articles with unsourced statements</a></span> | <span dir='ltr'><a href="/wiki/Category:Articles_with_unsourced_statements_from_March_2009" title="Category:Articles with unsourced statements from March 2009">Articles with unsourced statements from March 2009</a></span> | <span dir='ltr'><a href="/wiki/Category:Articles_with_unsourced_statements_from_June_2009" title="Category:Articles with unsourced statements from June 2009">Articles with unsourced statements from June 2009</a></span> | <span dir='ltr'><a href="/wiki/Category:Articles_with_unsourced_statements_from_January_2009" title="Category:Articles with unsourced statements from January 2009">Articles with unsourced statements from January 2009</a></span></div></div>  <div class="visualClear"></div> </div> </div> </div> <div id="column-one"> <div id="p-cactions" class="portlet"> <h5>Views</h5> <div class="pBody"> <ul lang="en" xml:lang="en"> <li id="ca-nstab-main" class="selected"><a href="/wiki/Gastroesophageal_reflux_disease" title="View the content page [c]" accesskey="c">Article</a></li> <li id="ca-talk"><a href="/wiki/Talk:Gastroesophageal_reflux_disease" title="Discussion about the content page [t]" accesskey="t">Discussion</a></li> <li id="ca-edit"><a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit" title="You can edit this page. 
Please use the preview button before saving. [e]" accesskey="e">Edit this page</a></li> <li id="ca-history"><a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=history" title="Past versions of this page [h]" accesskey="h">History</a></li> </ul> </div> </div> <div class="portlet" id="p-personal"> <h5>Personal tools</h5> <div class="pBody"> <ul lang="en" xml:lang="en"> <li id="pt-acaibeta"><a href="http://en.wikipedia.org/w/index.php?title=Special:UsabilityInitiativeOptIn&from=Gastroesophageal_reflux_disease" class="no-text-transform">Try Beta</a></li> <li id="pt-login"><a href="/w/index.php?title=Special:UserLogin&returnto=Gastroesophageal_reflux_disease" title="You are encouraged to log in; however, it is not mandatory. [o]" accesskey="o">Log in / create account</a></li> </ul> </div> </div> <div class="portlet" id="p-logo"> <a style="background-image: url(http://upload.wikimedia.org/wikipedia/en/b/bc/Wiki.png);" href="/wiki/Main_Page" title="Visit the main page [z]" accesskey="z"></a> </div> <script type="text/javascript"> if (window.isMSIE55) fixalpha(); </script> <div class='generated-sidebar portlet' id='p-navigation'> <h5 lang="en" xml:lang="en">Navigation</h5> <div class='pBody'> <ul> <li id="n-mainpage-description"><a href="/wiki/Main_Page" title="Visit the main page [z]" accesskey="z">Main page</a></li> <li id="n-contents"><a href="/wiki/Portal:Contents" title="Guides to browsing Wikipedia">Contents</a></li> <li id="n-featuredcontent"><a href="/wiki/Portal:Featured_content" title="Featured content — the best of Wikipedia">Featured content</a></li> <li id="n-currentevents"><a href="/wiki/Portal:Current_events" title="Find background information on current events">Current events</a></li> <li id="n-randompage"><a href="/wiki/Special:Random" title="Load a random article [x]" accesskey="x">Random article</a></li> </ul> </div> </div> <div id="p-search" class="portlet"> <h5 lang="en" xml:lang="en"><label for="searchInput">Search</label></h5> <div id="searchBody" class="pBody"> <form action="/w/index.php" id="searchform"><div> <input type='hidden' name="title" value="Special:Search"/> <input id="searchInput" name="search" type="text" title="Search Wikipedia [f]" accesskey="f" value="" /> <input type='submit' name="go" class="searchButton" id="searchGoButton" value="Go" title="Go to a page with this exact name if one exists" />  <input type='submit' name="fulltext" class="searchButton" id="mw-searchButton" value="Search" title="Search Wikipedia for this text" /> </div></form> </div> </div> <div class='generated-sidebar portlet' id='p-interaction'> <h5 lang="en" xml:lang="en">Interaction</h5> <div class='pBody'> <ul> <li id="n-aboutsite"><a href="/wiki/Wikipedia:About" title="Find out about Wikipedia">About Wikipedia</a></li> <li id="n-portal"><a href="/wiki/Wikipedia:Community_portal" title="About the project, what you can do, where to find things">Community portal</a></li> <li id="n-recentchanges"><a href="/wiki/Special:RecentChanges" title="The list of recent changes in the wiki [r]" accesskey="r">Recent changes</a></li> <li id="n-contact"><a href="/wiki/Wikipedia:Contact_us" title="How to contact Wikipedia">Contact Wikipedia</a></li> <li id="n-sitesupport"><a href="http://wikimediafoundation.org/wiki/Donate/Now/en?utm_source=donate&utm_medium=sidebar&utm_campaign=spontaneous_d onation" title="Support us">Donate to Wikipedia</a></li> <li id="n-help"><a href="/wiki/Help:Contents" title="Guidance on how to use and edit Wikipedia">Help</a></li> </ul> </div> </div> <div class="portlet" id="p-tb"> <h5 lang="en" xml:lang="en">Toolbox</h5> <div class="pBody"> <ul> <li id="t-whatlinkshere"><a href="/wiki/Special:WhatLinksHere/Gastroesophageal_reflux_disease" title="List of all English Wikipedia pages containing links to this page [j]" accesskey="j">What links here</a></li> <li id="t-recentchangeslinked"><a href="/wiki/Special:RecentChangesLinked/Gastroesophageal_reflux_disease" title="Recent changes in pages linked from this page [k]" accesskey="k">Related changes</a></li> <li id="t-upload"><a href="/wiki/Wikipedia:Upload" title="Upload files [u]" accesskey="u">Upload file</a></li> <li id="t-specialpages"><a href="/wiki/Special:SpecialPages" title="List of all special pages [q]" accesskey="q">Special pages</a></li> <li id="t-print"><a href="/w/index.php?title=Gastroesophageal_reflux_disease&printable=yes" rel="alternate" title="Printable version of this page [p]" accesskey="p">Printable version</a></li> <li id="t-permalink"><a href="/w/index.php?title=Gastroesophageal_reflux_disease&oldid=306489498" title="Permanent link to this revision of the page">Permanent link</a></li><li id="t-cite"><a href="/w/index.php?title=Special:Cite&page=Gastroesophageal_reflux_disease&id=306489498">Cite this page</a></li> </ul> </div> </div> <div id="p-lang" class="portlet"> <h5 lang="en" xml:lang="en">Languages</h5> <div class="pBody"> <ul> <li class="interwiki-az"><a href="http://az.wikipedia.org/wiki/Qastro-ezofageal_reflyuks_x%C9%99st%C9%99liyi">Azərbaycan</a></li> <li class="interwiki-bs"><a href="http://bs.wikipedia.org/wiki/Gastroezofagealna_refluksna_bolest">Bosanski</a></li> <li class="interwiki-cs"><a href="http://cs.wikipedia.org/wiki/Gastroezofage%C3%A1ln%C3%AD_reflux">Česky</a></li> <li class="interwiki-de"><a href="http://de.wikipedia.org/wiki/Reflux%C3%B6sophagitis">Deutsch</a></li> <li class="interwiki-el"><a href="http://el.wikipedia.org/wiki/%CE%93%CE%B1%CF%83%CF%84%CF%81%CE%BF%CE%BF%CE%B9%CF%83%CE%BF%CF%86%CE%B1%CE%B3%CE%B9%CE%BA%C E%AE_%CF%80%CE%B1%CE%BB%CE%B9%CE%BD%CE%B4%CF%81%CE%BF%CE%BC%CE%B9%CE%BA%CE%AE_%CE%BD%CF%8C%CF%83%CE%BF%CF%82">Ελληνικά< /a></li> <li class="interwiki-fr"><a href="http://fr.wikipedia.org/wiki/Reflux_gastro-%C5%93sophagien">Français</a></li> <li class="interwiki-hi"><a href="http://hi.wikipedia.org/wiki/%E0%A4%8F%E0%A4%B8%E0%A4%BF%E0%A4%A1%E0%A4%BF%E0%A4%9F%E0%A5%80">हिन्दी</a></li> <li class="interwiki-hr"><a href="http://hr.wikipedia.org/wiki/Gastroezofagealna_refluksna_bolest">Hrvatski</a></li> <li class="interwiki-it"><a href="http://it.wikipedia.org/wiki/Malattia_da_reflusso_gastroesofageo">Italiano</a></li> <li class="interwiki-he"><a href="http://he.wikipedia.org/wiki/%D7%A8%D7%A4%D7%9C%D7%95%D7%A7%D7%A1_%D7%A7%D7%99%D7%91%D7%AA%D7%99_%D7%95%D7%A9%D7%98%D7%99 ">עברית</a></li> <li class="interwiki-ja"><a href="http://ja.wikipedia.org/wiki/%E9%80%86%E6%B5%81%E6%80%A7%E9%A3%9F%E9%81%93%E7%82%8E">日本語</a></li> <li class="interwiki-la"><a href="http://la.wikipedia.org/wiki/Oesophagitis_propter_reflux">Latina</a></li> <li class="interwiki-nl"><a href="http://nl.wikipedia.org/wiki/Oesofagale_reflux">Nederlands</a></li> <li class="interwiki-no"><a href="http://no.wikipedia.org/wiki/Gastro%C3%B8sofageal_refluks">‪Norsk (bokmål)‬</a></li> <li class="interwiki-pl"><a href="http://pl.wikipedia.org/wiki/Refluks_%C5%BCo%C5%82%C4%85dkowo-prze%C5%82ykowy">Polski</a></li> <li class="interwiki-pt"><a href="http://pt.wikipedia.org/wiki/Refluxo_gastroesof%C3%A1gico">Português</a></li> <li class="interwiki-ru"><a href="http://ru.wikipedia.org/wiki/%D0%93%D0%B0%D1%81%D1%82%D1%80%D0%BE%D1%8D%D0%B7%D0%BE%D1%84%D0%B0%D0%B3%D0%B5%D0%B0%D0%BB%D 1%8C%D0%BD%D0%B0%D1%8F_%D1%80%D0%B5%D1%84%D0%BB%D1%8E%D0%BA%D1%81%D0%BD%D0%B0%D1%8F_%D0%B1%D0%BE%D0%BB%D0%B5%D0%B7%D0%BD%D1%8C" >Русский</a></li> <li class="interwiki-sv"><a href="http://sv.wikipedia.org/wiki/Gastroesofageal_refluxsjukdom">Svenska</a></li> <li class="interwiki-th"><a href="http://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B8%81%E0%B8%A3%E0%B8%94%E0%B9%84%E0%B8%AB%E0%B8%A5%E0%B8%A2%E 0%B9%89%E0%B8%AD%E0%B8%99">ไทย</a></li> <li class="interwiki-tr"><a href="http://tr.wikipedia.org/wiki/Refl%C3%BC">Türkçe</a></li> <li class="interwiki-zh"><a href="http://zh.wikipedia.org/wiki/%E8%83%83%E9%A3%9F%E7%AE%A1%E5%8F%8D%E6%B5%81%E7%97%85">中文</a></li> </ul> </div> </div> </div> <div class="visualClear"></div> <div id="footer"> <div id="f-poweredbyico"><a href="http://www.mediawiki.org/"><img src="/skins-1.5/common/images/poweredby_mediawiki_88x31.png" alt="Powered by MediaWiki" /></a></div> <div id="f-copyrightico"><a href="http://wikimediafoundation.org/"><img src="/images/wikimedia-button.png" alt="Wikimedia Foundation"/></a></div> <ul id="f-list"> <li id="lastmod"> This pa <div id="globalWrapper"> <div id="column-content"> <div id="content"> <a name="top" id="top"></a> <div id="siteNotice"><script type='text/javascript'>if (wgNotice != '') document.writeln(wgNotice);</script></div> <h1 id="firstHeading" class="firstHeading">Gastroesophageal reflux disease</h1> <div id="bodyContent"> <h3 id="siteSub">From Wikipedia, the free encyclopedia</h3> <div id="contentSub"> (Redirected from <a href="/w/index.php?title=Acid_reflux&redirect=no" title="Acid reflux">Acid reflux</a>)</div> <div id="jump-to-nav">Jump to: <a href="#column-one">navigation</a>, <a href="#searchInput">search</a></div>  <table class="infobox" cellspacing="5" style="width: 22em; text-align: left; font-size: 88%; line-height: 1.5em;"> <tr> <td colspan="2" class="" style="text-align:center; font-size: 125%; font-weight: bold; background-color: lightgrey">Gastroesophageal reflux disease</td> </tr> <tr> <td colspan="2" class="" style="text-align:center;"><i>Classification and external resources</i></td> </tr> <tr> <td colspan="2" class="" style="text-align:center;"><a href="/wiki/File:Gastroesophageal_reflux_barium_X-ray.jpg" class="image" title="Gastroesophageal reflux barium X-ray.jpg"><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/5/56/Gastroesophageal_reflux_barium_X-ray.jpg/190px-Gastroesophageal_r eflux_barium_X-ray.jpg" width="190" height="232" /></a><br /> <span style="">X-ray of the abdomen and chest in a patient with a <a href="/wiki/Gastrostomy" title="Gastrostomy">gastrostomy</a>. <a href="/wiki/Radiocontrast" title="Radiocontrast">Radiocontrast</a> was injected into the stomach and quickly seen migrating upwards through the entire <a href="/wiki/Esophagus" title="Esophagus">esophagus</a>. The patient had severe reflux-induced <a href="/wiki/Esophagitis" title="Esophagitis">esophagitis</a>.</span></td> </tr> <tr> <th style=""><a href="/wiki/ICD" title="ICD" class="mw-redirect">ICD</a>-<a href="/wiki/List_of_ICD-10_codes" title="List of ICD-10 codes" class="mw-redirect">10</a></th> <td class="" style=""><a href="/wiki/ICD-10_Chapter_K" title="ICD-10 Chapter K" class="mw-redirect">K</a><a href="http://apps.who.int/classifications/apps/icd/icd10online/?gk20.htm+k21" class="external text" title="http://apps.who.int/classifications/apps/icd/icd10online/?gk20.htm+k21" rel="nofollow">21.</a></td> </tr> <tr> <th style=""><a href="/wiki/ICD" title="ICD" class="mw-redirect">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9</a></th> <td class="" style=""><a href="http://www.icd9data.com/getICD9Code.ashx?icd9=530.81" class="external text" title="http://www.icd9data.com/getICD9Code.ashx?icd9=530.81" rel="nofollow">530.81</a></td> </tr> <tr> <th style=""><a href="/wiki/OMIM" title="OMIM" class="mw-redirect">OMIM</a></th> <td class="" style=""><a href="http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=109350" class="external text" title="http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=109350" rel="nofollow">109350</a></td> </tr> <tr> <th style=""><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></th> <td class="" style=""><a href="http://www.diseasesdatabase.com/ddb23596.htm" class="external text" title="http://www.diseasesdatabase.com/ddb23596.htm" rel="nofollow">23596</a></td> </tr> <tr> <th style=""><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></th> <td class="" style=""><a href="http://www.emedicine.com/med/topic857.htm" class="external text" title="http://www.emedicine.com/med/topic857.htm" rel="nofollow">med/857</a>  <a href="http://www.emedicine.com/ped/topic1177.htm#" class="external text" title="http://www.emedicine.com/ped/topic1177.htm#" rel="nofollow">ped/1177</a> <a href="http://www.emedicine.com/radio/topic300.htm#" class="external text" title="http://www.emedicine.com/radio/topic300.htm#" rel="nofollow">radio/300</a></td> </tr> <tr> <th style=""><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></th> <td class="" style=""><a href="http://www.nlm.nih.gov/cgi/mesh/2009/MB_cgi?field=uid&term=D005764" class="external autonumber" title="http://www.nlm.nih.gov/cgi/mesh/2009/MB_cgi?field=uid&term=D005764" rel="nofollow">[2]</a></td> </tr> </table> <p><b>Gastroesophageal reflux disease</b> <b>(GERD)</b>, <b>Gastro-oesophageal reflux disease</b> <b>(GORD)</b>, <b>Gastric reflux disease</b>, or <b>Acid reflux disease</b> is defined as chronic symptoms or <a href="/wiki/Mucosa" title="Mucosa" class="mw-redirect">mucosal</a> damage produced by the abnormal reflux in the <a href="/wiki/Esophagus" title="Esophagus">esophagus</a>.<sup id="cite_ref-0" class="reference"><a href="#cite_note-0"><span>[</span>1<span>]</span></a></sup></p> <p>This is commonly due to transient or permanent changes in the barrier between the esophagus and the <a href="/wiki/Stomach" title="Stomach">stomach</a>. This can be due to incompetence of the <a href="/wiki/Lower_esophageal_sphincter" title="Lower esophageal sphincter" class="mw-redirect">lower esophageal sphincter</a>, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, or a <a href="/wiki/Hiatal_hernia" title="Hiatal hernia" class="mw-redirect">hiatal hernia</a>. If the reflux reaches the throat, it is called <a href="/wiki/Laryngopharyngeal_reflux_disease" title="Laryngopharyngeal reflux disease" class="mw-redirect">laryngopharyngeal reflux disease</a>.</p> <table id="toc" class="toc" summary="Contents"> <tr> <td> <div id="toctitle"> <h2>Contents</h2> </div> <ul> <li class="toclevel-1"><a href="#Signs_and_symptoms"><span class="tocnumber">1</span> <span class="toctext">Signs and symptoms</span></a> <ul> <li class="toclevel-2"><a href="#Adults"><span class="tocnumber">1.1</span> <span class="toctext">Adults</span></a></li> <li class="toclevel-2"><a href="#Children"><span class="tocnumber">1.2</span> <span class="toctext">Children</span></a></li> <li class="toclevel-2"><a href="#Barrett.27s_esophagus"><span class="tocnumber">1.3</span> <span class="toctext">Barrett's esophagus</span></a></li> </ul> </li> <li class="toclevel-1"><a href="#Diagnosis"><span class="tocnumber">2</span> <span class="toctext">Diagnosis</span></a></li> <li class="toclevel-1"><a href="#Pathophysiology"><span class="tocnumber">3</span> <span class="toctext">Pathophysiology</span></a></li> <li class="toclevel-1"><a href="#Treatment"><span class="tocnumber">4</span> <span class="toctext">Treatment</span></a> <ul> <li class="toclevel-2"><a href="#Lifestyle_modifications"><span class="tocnumber">4.1</span> <span class="toctext">Lifestyle modifications</span></a></li> <li class="toclevel-2"><a href="#Medications"><span class="tocnumber">4.2</span> <span class="toctext">Medications</span></a></li> <li class="toclevel-2"><a href="#Surgical_treatments"><span class="tocnumber">4.3</span> <span class="toctext">Surgical treatments</span></a></li> <li class="toclevel-2"><a href="#Other_treatments"><span class="tocnumber">4.4</span> <span class="toctext">Other treatments</span></a></li> </ul> </li> <li class="toclevel-1"><a href="#References"><span class="tocnumber">5</span> <span class="toctext">References</span></a></li> <li class="toclevel-1"><a href="#External_links"><span class="tocnumber">6</span> <span class="toctext">External links</span></a></li> </ul> </td> </tr> </table> <script type="text/javascript"> //<![CDATA[ if (window.showTocToggle) { var tocShowText = "show"; var tocHideText = "hide"; showTocToggle(); } //]]> </script> <p><a name="Signs_and_symptoms" id="Signs_and_symptoms"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=1" title="Edit section: Signs and symptoms">edit</a>]</span> <span class="mw-headline">Signs and symptoms</span></h2> <p><a name="Adults" id="Adults"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=2" title="Edit section: Adults">edit</a>]</span> <span class="mw-headline">Adults</span></h3> <p>The most-common symptoms of GERD are:</p> <ul> <li><a href="/wiki/Heartburn" title="Heartburn">Heartburn</a></li> <li><a href="/wiki/Regurgitation_(digestion)" title="Regurgitation (digestion)">Regurgitation</a></li> <li>Trouble swallowing (<a href="/wiki/Dysphagia" title="Dysphagia">dysphagia</a>)</li> </ul> <p>Less-common symptoms include:</p> <ul> <li>Pain with swallowing (<a href="/wiki/Odynophagia" title="Odynophagia">odynophagia</a>)</li> <li>Excessive salivation (this is common during heartburn, as saliva is generally slightly basic<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span>[</span>2<span>]</span></a></sup> and is the body's natural response to heartburn, acting similarly to an antacid)</li> <li>Nausea<sup id="cite_ref-Kahrilas_2-0" class="reference"><a href="#cite_note-Kahrilas-2"><span>[</span>3<span>]</span></a></sup></li> <li>Chest pain</li> </ul> <p>GERD sometimes causes injury of the esophagus. These injuries may include:</p> <ul> <li><a href="/wiki/Reflux_esophagitis" title="Reflux esophagitis" class="mw-redirect">Reflux esophagitis</a>—<a href="/wiki/Necrosis" title="Necrosis">necrosis</a> of esophageal epithelium causing ulcers near the junction of the stomach and esophagus.</li> <li><a href="/wiki/Esophageal_stricture" title="Esophageal stricture">Esophageal strictures</a>—the persistent narrowing of the esophagus caused by reflux-induced inflammation.</li> <li><a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a>—<a href="/wiki/Metaplasia" title="Metaplasia">metaplasia</a> (changes of the epithelial cells from squamous to columnar epithelium) of the distal esophagus.</li> <li><a href="/wiki/Esophageal_adenocarcinoma" title="Esophageal adenocarcinoma" class="mw-redirect">Esophageal adenocarcinoma</a>—a rare form of cancer.<sup id="cite_ref-Kahrilas_2-1" class="reference"><a href="#cite_note-Kahrilas-2"><span>[</span>3<span>]</span></a></sup></li> </ul> <p>Several other atypical symptoms are associated with GERD, but there is good evidence for causation only when they are accompanied by esophageal injury. These symptoms are:</p> <ul> <li>Chronic cough</li> <li><a href="/wiki/Laryngitis" title="Laryngitis">Laryngitis</a> (hoarseness, throat clearing)</li> <li><a href="/wiki/Asthma" title="Asthma">Asthma</a></li> <li>Erosion of dental enamel</li> <li><a href="/wiki/Dentine_hypersensitivity" title="Dentine hypersensitivity">Dentine hypersensitivity</a></li> <li>Sinusitis and damaged teeth<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span>[</span>4<span>]</span></a></sup></li> </ul> <p>Some people have proposed that symptoms such as <a href="/wiki/Pharyngitis" title="Pharyngitis" class="mw-redirect">pharyngitis</a>, <a href="/wiki/Sinusitis" title="Sinusitis">sinusitis</a>, recurrent ear infections, and <a href="/wiki/Idiopathic_pulmonary_fibrosis" title="Idiopathic pulmonary fibrosis">idiopathic pulmonary fibrosis</a> are due to GERD; however, a causative role has not been established.<sup id="cite_ref-Kahrilas_2-2" class="reference"><a href="#cite_note-Kahrilas-2"><span>[</span>3<span>]</span></a></sup></p> <p><a name="Children" id="Children"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=3" title="Edit section: Children">edit</a>]</span> <span class="mw-headline">Children</span></h3> <p>GERD may be difficult to detect in <a href="/wiki/Infant" title="Infant">infants</a> and <a href="/wiki/Child" title="Child">children</a>. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>, effortless spitting up, <a href="/wiki/Coughing" title="Coughing" class="mw-redirect">coughing</a>, and other respiratory problems. Inconsolable crying, failure to gain adequate weight, refusing food, bad breath, and <a href="/wiki/Belching" title="Belching">belching</a> or <a href="/wiki/Burping" title="Burping" class="mw-redirect">burping</a> are also common. Children may have one symptom or many — no single symptom is universal in all children with GERD.</p> <p><b>Common symptoms of Paediatric Reflux</b></p> <ul> <li>Irritability and pain, sometimes screaming suddenly when asleep. Constant or sudden crying or “colic” like</li> </ul> <p>symptoms. Babies can be inconsolable especially when laid down flat.</p> <ul> <li>Poor sleep habits typically with arching their necks and back during or after feeding</li> <li>Excessive possetting or vomiting</li> <li>Frequent burping or frequent hiccups</li> <li>Excessive dribbling or running nose</li> <li>Swallowing problems, gagging and choking</li> <li>Frequent ear infections or sinus congestion</li> <li>Babies are often very gassy and extremely difficult to “burp” after feeds</li> <li>Refusing feeds or frequent feeds for comfort</li> <li>Night time coughing, extreme cases of acid reflux can cause apnoea and respiratory problems such as asthma, bronchitis and pneumonia if stomach contents are inhaled.</li> <li>Bad breath – smelling acidy</li> <li>Rancid/acid smelling diapers with loose stool. Bowel movements can be very frequent or babies can be constipated.</li> </ul> <p><b>Vomiting feeds</b> Possetting after a feed is quite normal with most infants. They gain weight, feed well and have no other symptoms, but still this can be upsetting for parents. As the child gets older the lower oesophageal sphincter becomes more competent so the vomiting should begin to show signs of improvement and eventually stop. Some babies suffer more with reflux and about 60% of these babies with persistent reflux may have weight gain issues. <i>It is a very popular misconception</i> though that all babies and children with reflux are underweight<i>. This isn't always the case, some may comfort eat and</i> feed very frequently and not all are sick. Many doctors advise that babies outgrow reflux once they can sit up, or once they stand. Many do, but some will not only fail to outgrow it, but will noticeably worsen with developmental milestones, teething episodes, viral illness and weaning.</p> <p><b>Silent Reflux</b> Some babies with reflux do not vomit at all. This is actually more of a problem because the acidic stomach contents go up the throat and back down again, causing twice the pain and twice the damage.<sup class="noprint Template-Fact" title="This claim needs references to reliable sources from March 2009" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a></i>]</sup> There is no clear relationship between symptoms and the severity of reflux.</p> <p>It is estimated that of the approximately 4 million babies born in the U.S. each year, up to 35% of them may have difficulties with reflux in the first few months of their life, known as <i>spitting up</i>.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span>[</span>5<span>]</span></a></sup> Most of those children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true where there is a family history of GERD present.</p> <p><a name="Barrett.27s_esophagus" id="Barrett.27s_esophagus"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=4" title="Edit section: Barrett's esophagus">edit</a>]</span> <span class="mw-headline">Barrett's esophagus</span></h3> <div class="rellink noprint relarticle mainarticle">Main article: <a href="/wiki/Barrett%27s_Esophagus" title="Barrett's Esophagus" class="mw-redirect">Barrett's Esophagus</a></div> <p>GERD may lead to <a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a>, a type of <a href="/wiki/Metaplasia" title="Metaplasia">metaplasia</a> which is in turn a precursor condition for carcinoma. The risk of progression from Barrett's to dysplasia is uncertain but is estimated at about 20% of cases.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span>[</span>6<span>]</span></a></sup> Due to the risk of chronic heartburn progressing to Barrett's, EGD every 5 years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD.<sup class="noprint Template-Fact" title="This claim needs references to reliable sources from June 2009" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a></i>]</sup></p> <p><a name="Diagnosis" id="Diagnosis"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=5" title="Edit section: Diagnosis">edit</a>]</span> <span class="mw-headline">Diagnosis</span></h2> <div class="thumb tright"> <div class="thumbinner" style="width:202px;"><a href="/wiki/File:Peptic_stricture.png" class="image" title="Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach. This is a complication of chronic gastroesophageal reflux disease and can be a cause of dysphagia or difficulty swallowing"><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/1/16/Peptic_stricture.png/200px-Peptic_stricture.png" width="200" height="195" class="thumbimage" /></a> <div class="thumbcaption"> <div class="magnify"><a href="/wiki/File:Peptic_stricture.png" class="internal" title="Enlarge"><img src="/skins-1.5/common/images/magnify-clip.png" width="15" height="11" alt="" /></a></div> <a href="/wiki/Gastroscopy" title="Gastroscopy" class="mw-redirect">Endoscopic</a> image of peptic stricture, or narrowing of the <a href="/wiki/Esophagus" title="Esophagus">esophagus</a> near the junction with the <a href="/wiki/Stomach" title="Stomach">stomach</a>. This is a complication of chronic gastroesophageal reflux disease and can be a cause of <a href="/wiki/Dysphagia" title="Dysphagia">dysphagia</a> or difficulty swallowing</div> </div> </div> <p>A detailed historical knowledge is vital for an accurate diagnosis. Useful investigations may include <a href="/wiki/Barium" title="Barium">barium</a> swallow <a href="/wiki/X-ray" title="X-ray">X-rays</a>, <a href="/wiki/Esophageal_motility_study" title="Esophageal motility study">esophageal manometry</a>, 24 hour esophageal <a href="/wiki/Impedance-pH_monitoring" title="Impedance-pH monitoring">impedance-pH monitoring</a>, and <a href="/wiki/Esophagogastroduodenoscopy" title="Esophagogastroduodenoscopy">Esophagogastroduodenoscopy</a> (EGD). In general, an EGD is done when the patient either does not respond well to treatment or has alarm symptoms including <a href="/wiki/Dysphagia" title="Dysphagia">dysphagia</a>, anemia, blood in the stool (detected chemically), <a href="/wiki/Asthma" title="Asthma">wheezing</a>, weight loss, or voice changes. Some physicians advocate either once-in-a-lifetime or 5/10-yearly endoscopy for patients with longstanding GERD, to evaluate the possible presence of dysplasia or <a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a>, a precursor lesion for <a href="/wiki/Esophageal_cancer" title="Esophageal cancer">esophageal adenocarcinoma</a>.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span>[</span>7<span>]</span></a></sup></p> <p><a href="/wiki/Esophagogastroduodenoscopy" title="Esophagogastroduodenoscopy">Esophagogastroduodenoscopy</a> (EGD) (a form of <a href="/wiki/Endoscopy" title="Endoscopy">endoscopy</a>) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surfaces of the esophagus, stomach, and <a href="/wiki/Duodenum" title="Duodenum">duodenum</a>.</p> <p><a href="/wiki/Biopsy" title="Biopsy">Biopsies</a> can be performed during gastroscopy and these may show:</p> <ul> <li>Edema and basal hyperplasia (non-specific inflammatory changes)</li> <li>Lymphocytic inflammation (non-specific)</li> <li>Neutrophilic inflammation (usually due to reflux or <i><a href="/wiki/Helicobacter" title="Helicobacter">Helicobacter</a></i> <a href="/wiki/Gastritis" title="Gastritis">gastritis</a>)</li> <li>Eosinophilic inflammation (usually due to reflux)</li> <li>Goblet cell intestinal metaplasia or Barretts esophagus</li> <li>Elongation of the papillae</li> <li>Thinning of the squamous cell layer</li> <li><a href="/wiki/Dysplasia" title="Dysplasia">Dysplasia</a> or pre-cancer</li> <li><a href="/wiki/Carcinoma" title="Carcinoma">Carcinoma</a></li> </ul> <p>Reflux changes may be non-erosive in nature, leading to the entity "non-erosive reflux disease".</p> <p>Another test that has been used is the "Bernstein test".<sup id="cite_ref-pmid15056077_7-0" class="reference"><a href="#cite_note-pmid15056077-7"><span>[</span>8<span>]</span></a></sup></p> <p><a name="Pathophysiology" id="Pathophysiology"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=6" title="Edit section: Pathophysiology">edit</a>]</span> <span class="mw-headline">Pathophysiology</span></h2> <p>GERD is caused by a failure of the <a href="/wiki/Cardia" title="Cardia">cardia</a>. In healthy patients, the "Angle of His"—the angle at which the esophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue.</p> <p>Another paradoxical cause of GERD-like symptoms is not enough stomach acid (<a href="/wiki/Hypochlorhydria" title="Hypochlorhydria" class="mw-redirect">hypochlorhydria</a>). The valve that empties the stomach into the intestines is triggered by acidity. If there is not enough acid, this valve does not open, and the stomach contents are churned up into the esophagus. However, there is still enough acidity to irritate the esophagus.</p> <p>Factors that can contribute to GERD:</p> <ul> <li><a href="/wiki/Hiatal_hernia" title="Hiatal hernia" class="mw-redirect">Hiatal hernia</a>, which increases the likelihood of GERD due to mechanical and motility factors.<sup id="cite_ref-pmid17573791_8-0" class="reference"><a href="#cite_note-pmid17573791-8"><span>[</span>9<span>]</span></a></sup></li> <li><a href="/wiki/Obesity" title="Obesity">Obesity</a>: increasing <a href="/wiki/Body_mass_index" title="Body mass index">body mass index</a> is associated with more severe GERD.<sup id="cite_ref-pmid175737910_9-0" class="reference"><a href="#cite_note-pmid175737910-9"><span>[</span>10<span>]</span></a></sup></li> <li><a href="/wiki/Zollinger-Ellison_syndrome" title="Zollinger-Ellison syndrome">Zollinger-Ellison syndrome</a>, which can be present with increased gastric acidity due to <a href="/wiki/Gastrin" title="Gastrin">gastrin</a> production</li> <li><a href="/wiki/Hypercalcemia" title="Hypercalcemia" class="mw-redirect">Hypercalcemia</a>, which can increase <a href="/wiki/Gastrin" title="Gastrin">gastrin</a> production, leading to increased acidity</li> <li><a href="/wiki/Scleroderma" title="Scleroderma">Scleroderma</a> and <a href="/wiki/Systemic_sclerosis" title="Systemic sclerosis" class="mw-redirect">systemic sclerosis</a>, which can feature esophageal dysmotility</li> <li>The use of medicines such as <a href="/wiki/Prednisolone" title="Prednisolone">prednisolone</a></li> <li><a href="/wiki/Visceroptosis" title="Visceroptosis">Visceroptosis</a> or Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.</li> </ul> <p>GERD has been linked to <a href="/wiki/Laryngitis" title="Laryngitis">laryngitis</a>, chronic <a href="/wiki/Cough" title="Cough">cough</a>, <a href="/wiki/Pulmonary_fibrosis" title="Pulmonary fibrosis" class="mw-redirect">pulmonary fibrosis</a>, <a href="/wiki/Earache" title="Earache" class="mw-redirect">earache</a>, and <a href="/wiki/Asthma" title="Asthma">asthma</a>, even when not clinically apparent, as well as to <a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">laryngopharyngeal reflux</a> and ulcers of the <a href="/wiki/Vocal_cords" title="Vocal cords" class="mw-redirect">vocal cords</a>.</p> <p>Factors that have been linked with GERD but not conclusively:</p> <ul> <li><a href="/wiki/Sleep_apnea" title="Sleep apnea">Obstructive sleep apnea</a><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span>[</span>11<span>]</span></a></sup><sup id="cite_ref-pmid17198758_11-0" class="reference"><a href="#cite_note-pmid17198758-11"><span>[</span>12<span>]</span></a></sup></li> <li><a href="/wiki/Gallstones" title="Gallstones" class="mw-redirect">Gallstones</a>, which can impede the flow of <a href="/wiki/Bile" title="Bile">bile</a> into the <a href="/wiki/Duodenum" title="Duodenum">Duodenum</a>, which can affect the ability to neutralize <a href="/wiki/Gastric_acid" title="Gastric acid">gastric acid</a></li> </ul> <p>In 1999, a review of existing studies found that, on average, 40% of GERD patients also had <i><a href="/wiki/H._pylori" title="H. pylori" class="mw-redirect">H. pylori</a></i> infection.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span>[</span>13<span>]</span></a></sup> The eradication of <i>H. pylori</i> can lead to an increase in acid secretion,<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span>[</span>14<span>]</span></a></sup> leading to the question of whether <i>H. pylori</i>-infected GERD patients are any different than non-infected GERD patients. A <a href="/wiki/Double-blind" title="Double-blind" class="mw-redirect">double-blind</a> study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span>[</span>15<span>]</span></a></sup></p> <p><a name="Treatment" id="Treatment"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=7" title="Edit section: Treatment">edit</a>]</span> <span class="mw-headline">Treatment</span></h2> <p>Three classes of treatments exist for GERD. These include lifestyle modifications, medications, and surgery.</p> <p><a name="Lifestyle_modifications" id="Lifestyle_modifications"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=8" title="Edit section: Lifestyle modifications">edit</a>]</span> <span class="mw-headline">Lifestyle modifications</span></h3> <dl> <dt>Dietary modification</dt> </dl> <p>Certain foods and lifestyle are considered to promote gastroesophageal reflux, but a 2006 review suggested that evidence for most dietary interventions is anecdotal; only <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a> and elevating the head of the bed were supported by evidence.<sup id="cite_ref-pmid16682569_15-0" class="reference"><a href="#cite_note-pmid16682569-15"><span>[</span>16<span>]</span></a></sup> A subsequent randomized <a href="/wiki/Crossover_study" title="Crossover study">crossover study</a> showed benefit by avoiding eating two hours before bedtime.<sup id="cite_ref-pmid17573791_8-1" class="reference"><a href="#cite_note-pmid17573791-8"><span>[</span>9<span>]</span></a></sup></p> <ul> <li><a href="/wiki/Coffee" title="Coffee">Coffee</a>, <a href="/wiki/Alcoholic_beverage" title="Alcoholic beverage">alcohol</a>, and excessive amounts of <a href="/wiki/Vitamin_C" title="Vitamin C">Vitamin C</a> supplements stimulate gastric acid secretion. Taking these before bedtime especially can cause evening reflux.</li> <li><a href="/wiki/Antacids" title="Antacids" class="mw-redirect">Antacids</a> based on <a href="/wiki/Calcium_carbonate" title="Calcium carbonate">calcium carbonate</a> (but not <a href="/wiki/Aluminum_hydroxide" title="Aluminum hydroxide" class="mw-redirect">aluminum hydroxide</a>) were found to actually increase the acidity of the stomach. However, all antacids reduced acidity in the lower esophagus, so the net effect on GERD symptoms may still be positive.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span>[</span>17<span>]</span></a></sup></li> <li>Foods high in fats and <a href="/wiki/Tobacco_smoking" title="Tobacco smoking">smoking</a> reduce lower esophageal sphincter competence, so avoiding these may help. Fat also delays stomach emptying.</li> <li>Eating within 2–3 hours before bedtime.</li> <li>Large meals. Having smaller, more frequent meals reduces GERD risk, as it means there is less food in the stomach at any one time.</li> <li>Carbonated soft drinks with or without sugar.</li> <li><a href="/wiki/Chocolate" title="Chocolate">Chocolate</a> and <a href="/wiki/Peppermint" title="Peppermint">peppermint</a>.</li> <li><a href="/wiki/Acid" title="Acid">Acidic</a> foods: <a href="/wiki/Tomato" title="Tomato">tomatoes</a> and tomato-based preparations; <a href="/wiki/Citrus_fruits" title="Citrus fruits" class="mw-redirect">citrus fruits</a> and citrus juices.</li> <li><a href="/wiki/Cruciferous_vegetables" title="Cruciferous vegetables">Cruciferous vegetables</a>:cabbage, cauliflower, broccoli, and Brussels sprouts.</li> <li><a href="/wiki/Milk" title="Milk">Milk</a> and milk-based products containing calcium<sup class="noprint Template-Fact" title="This claim needs references to reliable sources from January 2009" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a></i>]</sup> and fat, within 2 hours of bedtime.</li> </ul> <dl> <dt>Positional therapy</dt> </dl> <p>Sleeping on the left side has been shown to reduce nighttime reflux episodes in patients.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span>[</span>18<span>]</span></a></sup></p> <p>A <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> suggested that elevating the head of bed is an effective therapy, although this conclusion was only supported by nonrandomized studies.<sup id="cite_ref-pmid16682569_15-1" class="reference"><a href="#cite_note-pmid16682569-15"><span>[</span>16<span>]</span></a></sup> The head of the bed can be elevated by plastic or wooden bed risers that support bed posts or legs, a therapeutic bed wedge pillow, or a wedge or an inflatable mattress lifter that fits in between mattress and box spring. The height of the elevation is critical and must be at least 6 to 8 inches (15 to 20 cm) to be at least minimally effective to prevent the backflow of gastric fluids. Some innerspring mattresses do not work well when inclined and may cause back pain; some prefer foam mattresses. Some practitioners use higher degrees of incline than provided by the commonly suggested 6 to 8 inches (15 to 20 cm) and claim greater success.</p> <p><a name="Medications" id="Medications"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=9" title="Edit section: Medications">edit</a>]</span> <span class="mw-headline">Medications</span></h3> <p>A number of drugs are approved to treat GERD, and are among the most-often-prescribed forms of <a href="/wiki/Medication" title="Medication" class="mw-redirect">medication</a> in most Western countries.</p> <ul> <li><a href="/wiki/Proton_pump_inhibitor" title="Proton pump inhibitor">Proton pump inhibitors</a> (such as <a href="/wiki/Omeprazole" title="Omeprazole">omeprazole</a>, <a href="/wiki/Pantoprazole" title="Pantoprazole">pantoprazole</a>, <a href="/wiki/Lansoprazole" title="Lansoprazole">lansoprazole</a>, and <a href="/wiki/Rabeprazole" title="Rabeprazole">rabeprazole</a>) are the most effective in reducing gastric acid secretion. These drugs stop acid secretion at the source of acid production, i.e., the proton pump.</li> <li>Gastric <a href="/wiki/H2_antagonist" title="H2 antagonist">H<sub>2</sub> receptor blockers</a> (such as <a href="/wiki/Ranitidine" title="Ranitidine">ranitidine</a>, <a href="/wiki/Famotidine" title="Famotidine">famotidine</a> and <a href="/wiki/Cimetidine" title="Cimetidine">cimetidine</a>) can reduce gastric secretion of acid. These drugs are technically <a href="/wiki/Antihistamine" title="Antihistamine" class="mw-redirect">antihistamines</a>. They relieve complaints in about 50% of all GERD patients. Compared to placebo (which also is associated with symptom improvement), they have a <a href="/wiki/Number_needed_to_treat" title="Number needed to treat">number needed to treat</a> of eight (8).<sup id="cite_ref-pmid17229239_18-0" class="reference"><a href="#cite_note-pmid17229239-18"><span>[</span>19<span>]</span></a></sup></li> <li><a href="/wiki/Antacid" title="Antacid">Antacids</a> before meals or symptomatically after symptoms begin can reduce gastric acidity (increase <a href="/wiki/PH" title="PH">pH</a>).</li> <li><a href="/wiki/Alginic_acid" title="Alginic acid">Alginic acid</a> (<a href="/wiki/Gaviscon" title="Gaviscon">Gaviscon</a>) may coat the mucosa as well as increase pH and decrease reflux. A <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> of <a href="/wiki/Randomized_controlled_trials" title="Randomized controlled trials" class="mw-redirect">randomized controlled trials</a> suggests <a href="/wiki/Alginic_acid" title="Alginic acid">alginic acid</a> may be the most effective of non-prescription treatments with a <a href="/wiki/Number_needed_to_treat" title="Number needed to treat">number needed to treat</a> of 4.<sup id="cite_ref-pmid17229239_18-1" class="reference"><a href="#cite_note-pmid17229239-18"><span>[</span>19<span>]</span></a></sup></li> <li><a href="/wiki/Prokinetic" title="Prokinetic" class="mw-redirect">Prokinetics</a> strengthen the lower esophageal sphincter (LES) and speed up gastric emptying. <a href="/wiki/Cisapride" title="Cisapride">Cisapride</a>, a member of this class, was withdrawn from the market for causing <a href="/wiki/Long_QT_syndrome" title="Long QT syndrome">Long QT syndrome</a> Reglan (metoclopramide) is a prokinetic with significant side effects called Tardive Dyskinesia/Dystonia. The United States Food and Drug Administration issued a Black Box Warning about Reglan in January 2009. A complete list of the symptoms of TD (plain English) are available at <sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span>[</span>20<span>]</span></a></sup></li> <li><a href="/wiki/Sucralfate" title="Sucralfate">Sucralfate</a> (Carafate) is also useful as an adjunct in helping to heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two (2) hours apart from meals and medications.</li> <li><a href="/wiki/Mosapride" title="Mosapride">Mosapride</a> citrate is a 5-HT4 receptor <a href="/wiki/Agonist" title="Agonist">agonist</a> used outside the United States largely as a therapy for GERD and <a href="/wiki/Dyspepsia" title="Dyspepsia">dyspepsia</a>.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span>[</span>21<span>]</span></a></sup></li> </ul> <p>Clinical trials which compare GERD treatments head-to-head provide physicians with critical information. Unfortunately most pharmaceutical-company sponsored studies are conducted versus placebo and not an active control. However, the DIAMOND has shown rough equivalence of efficacy between a "step-up" approach to therapy (antacids, followed by histamine antagonists, followed by PPIs) and a "step-down" approach (the reverse). The primary endpoint of the study was treatment success after 6 months, and was achieved for 70% of patients in "step-down" versus 72% of patients in "step-up".<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span>[</span>22<span>]</span></a></sup></p> <p><a name="Surgical_treatments" id="Surgical_treatments"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=10" title="Edit section: Surgical treatments">edit</a>]</span> <span class="mw-headline">Surgical treatments</span></h3> <p>The standard surgical treatment is the <i><a href="/wiki/Nissen_fundoplication" title="Nissen fundoplication">Nissen fundoplication</a></i>. In this procedure the upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done <a href="/wiki/Laparoscopic_surgery" title="Laparoscopic surgery">laparoscopically</a>.<sup id="cite_ref-Abbas_2004_22-0" class="reference"><a href="#cite_note-Abbas_2004-22"><span>[</span>23<span>]</span></a></sup> When compared to medical management laparoscopic fundoplication had better results at 1 year.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span>[</span>24<span>]</span></a></sup></p> <p>An obsolete treatment is <a href="/wiki/Vagotomy" title="Vagotomy">vagotomy</a> ("highly selective vagotomy"), the surgical removal of <a href="/wiki/Vagus_nerve" title="Vagus nerve">vagus nerve</a> branches that innervate the stomach lining. This treatment has been largely replaced by medication.</p> <p>Another treatment is transoral incisionless fundoplication (TIF) with the use of a device called Esophyx, which allows doctors to rebuild the valve between the stomach and the diaphragm by going through the esophagus.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span>[</span>25<span>]</span></a></sup></p> <p><a name="Other_treatments" id="Other_treatments"></a></p> <h3><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=11" title="Edit section: Other treatments">edit</a>]</span> <span class="mw-headline">Other treatments</span></h3> <p>In 2000 the U.S. <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration" class="mw-redirect">Food and Drug Administration</a> (FDA) approved two <a href="/wiki/Endoscopy" title="Endoscopy">endoscopic</a> devices to treat chronic heartburn. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. However, long-term results were disappointing, and the device is no longer sold by Bard. Another, the <a href="/wiki/Stretta_procedure" title="Stretta procedure">Stretta Procedure</a>, uses electrodes to apply radio frequency energy to the LES. The long-term outcomes of both procedures compared to a Nissen fundoplication are still being determined.</p> <p>Subsequently the NDO Surgical Plicator was cleared by the FDA for endoscopic GERD treatment. The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture-based implant. The company ceased operations in mid 2008, and the device is no longer on the market.</p> <p>Another treatment that involved injection of a solution during endoscopy into the lower esophageal wall was available for about one year ending in late 2005. It was marketed under the name Enteryx. It was removed from the market due to several reports of complications from misplaced injections.</p> <p><a name="References" id="References"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=12" title="Edit section: References">edit</a>]</span> <span class="mw-headline">References</span></h2> <div class="references-small references-column-count references-column-count-2" style="-moz-column-count:2; column-count:2;"> <ol class="references"> <li id="cite_note-0"><b><a href="#cite_ref-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFDeVault_KR.2C_Castell_DO1999">DeVault KR, Castell DO (1999). "Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology". <i>Am. J. Gastroenterol.</i> <b>94</b> (6): 1434–42. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1572-0241.1999.1123_a.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1572-0241.1999.1123_a.x" rel="nofollow">10.1111/j.1572-0241.1999.1123_a.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10364004" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/10364004">PMID 10364004</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Updated+ guidelines+for+the+diagnosis+and+treatment+of+gastroesophageal+reflux+disease.+The+Practice+Parameters+Committee+of+the+America n+College+of+Gastroenterology&rft.jtitle=Am.+J.+Gastroenterol.&rft.aulast=DeVault+KR%2C+Castell+DO&rft.au=DeVault+K R%2C+Castell+DO&rft.date=1999&rft.volume=94&rft.issue=6&rft.pages=1434%E2%80%9342&rft_id=info:doi/10.1111%2 Fj.1572-0241.1999.1123_a.x&rft_id=info:pmid/10364004&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"> <span style="display: none;"> </span></span></li> <li id="cite_note-1"><b><a href="#cite_ref-1">^</a></b> <a href="http://www.healingdaily.com/conditions/saliva-ph-test.htm" class="external free" title="http://www.healingdaily.com/conditions/saliva-ph-test.htm" rel="nofollow">http://www.healingdaily.com/conditions/saliva-ph-test.htm</a></li> <li id="cite_note-Kahrilas-2">^ <a href="#cite_ref-Kahrilas_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Kahrilas_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Kahrilas_2-2"><sup><i><b>c</b></i></sup></a> <cite style="font-style:normal" class="" id="CITEREFKahrilas.2C_PJ2008">Kahrilas, PJ (2008). "<a href="http://content.nejm.org/cgi/content/short/359/16/1700" class="external text" title="http://content.nejm.org/cgi/content/short/359/16/1700" rel="nofollow">Gastroesophageal Reflux Disease</a>". <i>New England Journal of Medicine.</i> <b>359</b> (16): 1700–1707. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1056%2FNEJMcp0804684" class="external text" title="http://dx.doi.org/10.1056%2FNEJMcp0804684" rel="nofollow">10.1056/NEJMcp0804684</a></span><span class="printonly">. <a href="http://content.nejm.org/cgi/content/short/359/16/1700" class="external free" title="http://content.nejm.org/cgi/content/short/359/16/1700" rel="nofollow">http://content.nejm.org/cgi/content/short/359/16/1700</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Gastroes ophageal+Reflux+Disease&rft.jtitle=New+England+Journal+of+Medicine.&rft.aulast=Kahrilas%2C+PJ&rft.au=Kahrilas%2C+PJ &rft.date=2008&rft.volume=359&rft.issue=16&rft.pages=1700%E2%80%931707&rft_id=info:doi/10.1056%2FNEJMcp0804 684&rft_id=http%3A%2F%2Fcontent.nejm.org%2Fcgi%2Fcontent%2Fshort%2F359%2F16%2F1700&rfr_id=info:sid/en.wikipedia.org:Gas troesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-3"><b><a href="#cite_ref-3">^</a></b> <a href="http://healthlink.mcw.edu/article/968784529.html" class="external autonumber" title="http://healthlink.mcw.edu/article/968784529.html" rel="nofollow">[1]</a></li> <li id="cite_note-4"><b><a href="#cite_ref-4">^</a></b> <cite style="font-style:normal" class="web">"<a href="http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html" class="external text" title="http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html" rel="nofollow">Spitting Up in Babies</a>". familydoctor.org<span class="printonly">. <a href="http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html" class="external free" title="http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html" rel="nofollow">http://familydoctor.org/online/famdocen/home/children/parents/infants/218.html</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Spitting+U p+in+Babies&rft.atitle=&rft.pub=familydoctor.org&rft_id=http%3A%2F%2Ffamilydoctor.org%2Fonline%2Ffamdocen%2Fhome%2F children%2Fparents%2Finfants%2F218.html&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-5"><b><a href="#cite_ref-5">^</a></b> <a href="http://www.gerd-library.com/dysplasia-and-barretts-esophagus/Dysplasia" class="external text" title="http://www.gerd-library.com/dysplasia-and-barretts-esophagus/Dysplasia" rel="nofollow">and Barrett’s Esophagus</a>. Retrieved on 2009-02-01.</li> <li id="cite_note-6"><b><a href="#cite_ref-6">^</a></b> <a href="http://www.gerd-library.com/diagnosis-endoscopy/" class="external text" title="http://www.gerd-library.com/diagnosis-endoscopy/" rel="nofollow">Diagnosis - Endoscopy</a>. Retrieved on 2009-03-20.</li> <li id="cite_note-pmid15056077-7"><b><a href="#cite_ref-pmid15056077_7-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFJung_B.2C_Steinbach_J.2C_Beaumont_C.2C_Mittal_RK2004">Jung B, Steinbach J, Beaumont C, Mittal RK (March 2004). "<a href="http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x" class="external text" title="http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x" rel="nofollow">Lack of association between esophageal acid sensitivity detected by prolonged pH monitoring and Bernstein testing</a>". <i>Am. J. Gastroenterol.</i> <b>99</b> (3): 410–5. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1572-0241.2004.04089.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1572-0241.2004.04089.x" rel="nofollow">10.1111/j.1572-0241.2004.04089.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15056077" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/15056077">PMID 15056077</a><span class="printonly">. <a href="http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x" class="external free" title="http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x" rel="nofollow">http://dx.doi.org/10.1111/j.1572-0241.2004.04089.x</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Lack+of+ association+between+esophageal+acid+sensitivity+detected+by+prolonged+pH+monitoring+and+Bernstein+testing&rft.jtitle=Am.+J. +Gastroenterol.&rft.aulast=Jung+B%2C+Steinbach+J%2C+Beaumont+C%2C+Mittal+RK&rft.au=Jung+B%2C+Steinbach+J%2C+Beaumont+C% 2C+Mittal+RK&rft.date=March+2004&rft.volume=99&rft.issue=3&rft.pages=410%E2%80%935&rft_id=info:doi/10.1111% 2Fj.1572-0241.2004.04089.x&rft_id=info:pmid/15056077&rft_id=http%3A%2F%2Fdx.doi.org%2F10.1111%2Fj.1572-0241.2004.04089. x&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid17573791-8">^ <a href="#cite_ref-pmid17573791_8-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-pmid17573791_8-1"><sup><i><b>b</b></i></sup></a> <cite style="font-style:normal" class="" id="CITEREFPiesman_M.2C_Hwang_I.2C_Maydonovitch_C.2C_Wong_RK2007">Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". <i>Am. J. Gastroenterol.</i> <b>102</b> (10): 2128–2134. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1572-0241.2007.01348.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1572-0241.2007.01348.x" rel="nofollow">10.1111/j.1572-0241.2007.01348.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17573791" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/17573791">PMID 17573791</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Nocturna l+reflux+episodes+following+the+administration+of+a+standardized+meal.+Does+timing+matter%3F&rft.jtitle=Am.+J.+Gastroentero l.&rft.aulast=Piesman+M%2C+Hwang+I%2C+Maydonovitch+C%2C+Wong+RK&rft.au=Piesman+M%2C+Hwang+I%2C+Maydonovitch+C%2C+Wong+R K&rft.date=2007&rft.volume=102&rft.issue=10&rft.pages=2128%E2%80%932134&rft_id=info:doi/10.1111%2Fj.1572-02 41.2007.01348.x&rft_id=info:pmid/17573791&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid175737910-9"><b><a href="#cite_ref-pmid175737910_9-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFAyazi_S.2C_Crookes_P.2C_Peyre_C.2C2007">Ayazi S, Crookes P, Peyre C, (2007). "Objective documentation of the link between gastroesophageal reflux disease and obesity". <i>Am. J. Gastroenterol.</i> <b>102</b> (S): 138–139.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Objectiv e+documentation+of+the+link+between+gastroesophageal+reflux+disease+and+obesity&rft.jtitle=Am.+J.+Gastroenterol.&rft.au last=Ayazi+S%2C+Crookes+P%2C+Peyre+C%2C&rft.au=Ayazi+S%2C+Crookes+P%2C+Peyre+C%2C&rft.date=2007&rft.volume=102& rft.issue=S&rft.pages=138%E2%80%93139&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-10"><b><a href="#cite_ref-10">^</a></b> <cite style="font-style:normal" class="" id="CITEREFMorse_CA.2C_Quan_SF.2C_Mays_MZ.2C_Green_C.2C_Stephen_G.2C_Fass_R2004">Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R (2004). "Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?". <i>Clin. Gastroenterol. Hepatol.</i> <b>2</b> (9): 761–8. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1016%2FS1542-3565%2804%2900347-7" class="external text" title="http://dx.doi.org/10.1016%2FS1542-3565%2804%2900347-7" rel="nofollow">10.1016/S1542-3565(04)00347-7</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15354276" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/15354276">PMID 15354276</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Is+there +a+relationship+between+obstructive+sleep+apnea+and+gastroesophageal+reflux+disease%3F&rft.jtitle=Clin.+Gastroenterol.+Hepa tol.&rft.aulast=Morse+CA%2C+Quan+SF%2C+Mays+MZ%2C+Green+C%2C+Stephen+G%2C+Fass+R&rft.au=Morse+CA%2C+Quan+SF%2C+Mays+MZ% 2C+Green+C%2C+Stephen+G%2C+Fass+R&rft.date=2004&rft.volume=2&rft.issue=9&rft.pages=761%E2%80%938&rft_id=inf o:doi/10.1016%2FS1542-3565%2804%2900347-7&rft_id=info:pmid/15354276&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_r eflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid17198758-11"><b><a href="#cite_ref-pmid17198758_11-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFKasasbeh_A.2C_Kasasbeh_E.2C_Krishnaswamy_G2007">Kasasbeh A, Kasasbeh E, Krishnaswamy G (2007). "Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex—a hypothetical review". <i>Sleep Med Rev</i> <b>11</b> (1): 47–58. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1016%2Fj.smrv.2006.05.001" class="external text" title="http://dx.doi.org/10.1016%2Fj.smrv.2006.05.001" rel="nofollow">10.1016/j.smrv.2006.05.001</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17198758" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/17198758">PMID 17198758</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Potentia l+mechanisms+connecting+asthma%2C+esophageal+reflux%2C+and+obesity%2Fsleep+apnea+complex%26mdash%3Ba+hypothetical+review&rf t.jtitle=Sleep+Med+Rev&rft.aulast=Kasasbeh+A%2C+Kasasbeh+E%2C+Krishnaswamy+G&rft.au=Kasasbeh+A%2C+Kasasbeh+E%2C+Krishna swamy+G&rft.date=2007&rft.volume=11&rft.issue=1&rft.pages=47%E2%80%9358&rft_id=info:doi/10.1016%2Fj.smrv.20 06.05.001&rft_id=info:pmid/17198758&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-12"><b><a href="#cite_ref-12">^</a></b> <cite style="font-style:normal" class="" id="CITEREFH.J._O.27Connor1999">H.J. O'Connor (Feb 1999). "Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management". <i>Aliment Pharmacol Ther</i> <b>13</b> (2): 117-27. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1046%2Fj.1365-2036.1999.00460.x" class="external text" title="http://dx.doi.org/10.1046%2Fj.1365-2036.1999.00460.x" rel="nofollow">10.1046/j.1365-2036.1999.00460.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10102940" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/10102940">PMID 10102940</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Helicoba cter+pylori+and+gastro-oesophageal+reflux+disease-clinical+implications+and+management&rft.jtitle=Aliment+Pharmacol+Ther&am p;rft.aulast=H.J.+O%27Connor&rft.au=H.J.+O%27Connor&rft.date=Feb+1999&rft.volume=13&rft.issue=2&rft.pages=1 17-27&rft_id=info:doi/10.1046%2Fj.1365-2036.1999.00460.x&rft_id=info:pmid/10102940&rfr_id=info:sid/en.wikipedia.org :Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-13"><b><a href="#cite_ref-13">^</a></b> <cite style="font-style:normal" class="" id="CITEREFEl-Omar_E.2C_Oien_K.2C_Nujuni_AE.2C_et_al.1997">El-Omar E, Oien K, Nujuni AE, et al. (1997). "Helicobacter pylori infection and chronic gastric acid hyposecretion". <i>Gastroenterology</i> <b>113</b>: 15–24 opt=Abstract. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9207257" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/9207257">PMID 9207257</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Helicoba cter+pylori+infection+and+chronic+gastric+acid+hyposecretion&rft.jtitle=Gastroenterology&rft.aulast=El-Omar+E%2C+Oien+K %2C+Nujuni+AE%2C+et+al.&rft.au=El-Omar+E%2C+Oien+K%2C+Nujuni+AE%2C+et+al.&rft.date=1997&rft.volume=113&rft.page s=15%E2%80%9324+opt%3DAbstract&rft_id=info:pmid/9207257&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_diseas e"><span style="display: none;"> </span></span></li> <li id="cite_note-14"><b><a href="#cite_ref-14">^</a></b> <cite style="font-style:normal" class="" id="CITEREFC.A._Fallone.2C_A.N._Barkun.2C_S._Mayrand.2C_G._Wakil.2C_G._Friedman.2C_A._Szilagyi.2C_C._Wheeler_.26_D._Ross2004">C .A. Fallone, A.N. Barkun, S. Mayrand, G. Wakil, G. Friedman, A. Szilagyi, C. Wheeler & D. Ross (2004). "<a href="http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART" class="external text" title="http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART" rel="nofollow">There is no difference in the disease severity of gastro-oesophageal reflux disease between patients infected and not infected with Helicobacter pylori</a>". <i>Aliment Pharmacol Ther</i> <b>20</b> (7): 761-768. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1365-2036.2004.02171.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1365-2036.2004.02171.x" rel="nofollow">10.1111/j.1365-2036.2004.02171.x</a></span><span class="printonly">. <a href="http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART" class="external free" title="http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART" rel="nofollow">http://www3.interscience.wiley.com/cgi-bin/fulltext/118774431/HTMLSTART</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=There+is +no+difference+in+the+disease+severity+of+gastro-oesophageal+reflux+disease+between+patients+infected+and+not+infected+with+Hel icobacter+pylori&rft.jtitle=Aliment+Pharmacol+Ther&rft.aulast=C.A.+Fallone%2C+A.N.+Barkun%2C+S.+Mayrand%2C+G.+Wakil%2C+ G.+Friedman%2C+A.+Szilagyi%2C+C.+Wheeler+%26+D.+Ross&rft.au=C.A.+Fallone%2C+A.N.+Barkun%2C+S.+Mayrand%2C+G.+Wakil%2C+G.+Fri edman%2C+A.+Szilagyi%2C+C.+Wheeler+%26+D.+Ross&rft.date=2004&rft.volume=20&rft.issue=7&rft.pages=761-768&rf t_id=info:doi/10.1111%2Fj.1365-2036.2004.02171.x&rft_id=http%3A%2F%2Fwww3.interscience.wiley.com%2Fcgi-bin%2Ffulltext%2F118 774431%2FHTMLSTART&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid16682569-15">^ <a href="#cite_ref-pmid16682569_15-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-pmid16682569_15-1"><sup><i><b>b</b></i></sup></a> <cite style="font-style:normal" class="" id="CITEREFKaltenbach_T.2C_Crockett_S.2C_Gerson_LB2006">Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". <i>Arch. Intern. Med.</i> <b>166</b> (9): 965–71. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1001%2Farchinte.166.9.965" class="external text" title="http://dx.doi.org/10.1001%2Farchinte.166.9.965" rel="nofollow">10.1001/archinte.166.9.965</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16682569" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/16682569">PMID 16682569</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Are+life style+measures+effective+in+patients+with+gastroesophageal+reflux+disease%3F+An+evidence-based+approach&rft.jtitle=Arch.+In tern.+Med.&rft.aulast=Kaltenbach+T%2C+Crockett+S%2C+Gerson+LB&rft.au=Kaltenbach+T%2C+Crockett+S%2C+Gerson+LB&rft.da te=2006&rft.volume=166&rft.issue=9&rft.pages=965%E2%80%9371&rft_id=info:doi/10.1001%2Farchinte.166.9.965&rf t_id=info:pmid/16682569&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-16"><b><a href="#cite_ref-16">^</a></b> <cite style="font-style:normal" class="" id="CITEREFDecktor_DL.2C_Robinson_M.2C_Maton_PN.2C_Lanza_FL.2C_Gottlieb_S1995">Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S (1995). "Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn". <i>Am J Ther</i> <b>2</b> (8): 546–552. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1097%2F00045391-199508000-00006" class="external text" title="http://dx.doi.org/10.1097%2F00045391-199508000-00006" rel="nofollow">10.1097/00045391-199508000-00006</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11854825" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/11854825">PMID 11854825</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Effects+ of+Aluminum%2FMagnesium+Hydroxide+and+Calcium+Carbonate+on+Esophageal+and+Gastric+pH+in+Subjects+with+Heartburn&rft.jtitle= Am+J+Ther&rft.aulast=Decktor+DL%2C+Robinson+M%2C+Maton+PN%2C+Lanza+FL%2C+Gottlieb+S&rft.au=Decktor+DL%2C+Robinson+M%2C+ Maton+PN%2C+Lanza+FL%2C+Gottlieb+S&rft.date=1995&rft.volume=2&rft.issue=8&rft.pages=546%E2%80%93552&rft_id= info:doi/10.1097%2F00045391-199508000-00006&rft_id=info:pmid/11854825&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal _reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-17"><b><a href="#cite_ref-17">^</a></b> <cite style="font-style:normal" class="" id="CITEREFKhouryCamacho-Lobato_L.2C_Katz_PO.2C_Mohiuddin_MA.2C_Castell_DO1999">Khoury, RM; Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO (1999). "Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease". <i>Am. J. Gastroenterol.</i> <b>94</b> (8): 2069–73. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1572-0241.1999.01279.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1572-0241.1999.01279.x" rel="nofollow">10.1111/j.1572-0241.1999.01279.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10445529" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/10445529">PMID 10445529</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Influenc e+of+spontaneous+sleep+positions+on+nighttime+recumbent+reflux+in+patients+with+gastroesophageal+reflux+disease&rft.jtitle= Am.+J.+Gastroenterol.&rft.aulast=Khoury&rft.aufirst=RM&rft.au=Khoury%2C+RM&rft.au=Camacho-Lobato+L%2C+Katz+PO%2 C+Mohiuddin+MA%2C+Castell+DO&rft.date=1999&rft.volume=94&rft.issue=8&rft.pages=2069%E2%80%9373&rft_id=info: doi/10.1111%2Fj.1572-0241.1999.01279.x&rft_id=info:pmid/10445529&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_refl ux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-pmid17229239-18">^ <a href="#cite_ref-pmid17229239_18-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-pmid17229239_18-1"><sup><i><b>b</b></i></sup></a> <cite style="font-style:normal" class="" id="CITEREFTran_T.2C_Lowry_A.2C_El-Serag_H2007">Tran T, Lowry A, El-Serag H (2007). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs". <i>Aliment Pharmacol Ther</i> <b>25</b> (2): 143–53. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1111%2Fj.1365-2036.2006.03135.x" class="external text" title="http://dx.doi.org/10.1111%2Fj.1365-2036.2006.03135.x" rel="nofollow">10.1111/j.1365-2036.2006.03135.x</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17229239" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/17229239">PMID 17229239</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Meta-ana lysis%3A+the+efficacy+of+over-the-counter+gastro-oesophageal+reflux+disease+drugs&rft.jtitle=Aliment+Pharmacol+Ther&rft .aulast=Tran+T%2C+Lowry+A%2C+El-Serag+H&rft.au=Tran+T%2C+Lowry+A%2C+El-Serag+H&rft.date=2007&rft.volume=25&rft. issue=2&rft.pages=143%E2%80%9353&rft_id=info:doi/10.1111%2Fj.1365-2036.2006.03135.x&rft_id=info:pmid/17229239&r fr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-19"><b><a href="#cite_ref-19">^</a></b> <a href="http://www.reflux.org/reflux/webdoc01.nsf/487b3ba0c2f1a4ff85256ff30009f061/6472ef5bda1863778525703b005b9c3e/$FILE/Tardive %20PGMay04Article.pdf" class="external free" title="http://www.reflux.org/reflux/webdoc01.nsf/487b3ba0c2f1a4ff85256ff30009f061/6472ef5bda1863778525703b005b9c3e/$FILE/Tardiv e%20PGMay04Article.pdf" rel="nofollow">http://www.reflux.org/reflux/webdoc01.nsf/487b3ba0c2f1a4ff85256ff30009f061/6472ef5bda1863778525703b005b9c3e/$FIL E/Tardive%20PGMay04Article.pdf</a></li> <li id="cite_note-20"><b><a href="#cite_ref-20">^</a></b> <cite style="font-style:normal" class="web">"<a href="http://www.medscape.com/viewarticle/518324_4" class="external text" title="http://www.medscape.com/viewarticle/518324_4" rel="nofollow">www.medscape.com</a>"<span class="printonly">. <a href="http://www.medscape.com/viewarticle/518324_4" class="external free" title="http://www.medscape.com/viewarticle/518324_4" rel="nofollow">http://www.medscape.com/viewarticle/518324_4</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=www.medsca pe.com&rft.atitle=&rft_id=http%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F518324_4&rfr_id=info:sid/en.wikipedia.org:G astroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-21"><b><a href="#cite_ref-21">^</a></b> <cite style="font-style:normal" class="" id="CITEREFvan_Marrewjik_et_al.2009">van Marrewjik et al. (2009). "Effect and cost-effectiveness of step-up versus step-down treatment with antacids, H2-receptor antagonists, and proton pump inhibitors in patients with new onset dyspepsia (DIAMOND study): a primary-care-based randomized controlled study". <i>The Lancet</i> <b>373</b>: 215–25. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1016%2FS0140-6736%2809%2960070-2" class="external text" title="http://dx.doi.org/10.1016%2FS0140-6736%2809%2960070-2" rel="nofollow">10.1016/S0140-6736(09)60070-2</a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Effect+a nd+cost-effectiveness+of+step-up+versus+step-down+treatment+with+antacids%2C+H2-receptor+antagonists%2C+and+proton+pump+inhibit ors+in+patients+with+new+onset+dyspepsia+%28DIAMOND+study%29%3A+a+primary-care-based+randomized+controlled+study&rft.jtitle =The+Lancet&rft.aulast=van+Marrewjik+et+al.&rft.au=van+Marrewjik+et+al.&rft.date=2009&rft.volume=373&rft.pa ges=215%E2%80%9325&rft_id=info:doi/10.1016%2FS0140-6736%2809%2960070-2&rfr_id=info:sid/en.wikipedia.org:Gastroesophagea l_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-Abbas_2004-22"><b><a href="#cite_ref-Abbas_2004_22-0">^</a></b> <cite style="font-style:normal" class="" id="CITEREFAbbas_A.2C_Deschamps_C.2C_Cassivi_SD.2C_et_al.2004">Abbas A, Deschamps C, Cassivi SD, et al. (2004). "The role of laparoscopic fundoplication in Barrett’s esophagus". <i>Annals of Thoracic Surgery</i> <b>77</b> (2): 393–396. <a href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<span class="neverexpand"><a href="http://dx.doi.org/10.1016%2FS0003-4975%2803%2901352-3" class="external text" title="http://dx.doi.org/10.1016%2FS0003-4975%2803%2901352-3" rel="nofollow">10.1016/S0003-4975(03)01352-3</a></span>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14759403" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/14759403">PMID 14759403</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+role +of+laparoscopic+fundoplication+in+Barrett%E2%80%99s+esophagus&rft.jtitle=Annals+of+Thoracic+Surgery&rft.aulast=Abbas+A %2C+Deschamps+C%2C+Cassivi+SD%2C+et+al.&rft.au=Abbas+A%2C+Deschamps+C%2C+Cassivi+SD%2C+et+al.&rft.date=2004&rft.vol ume=77&rft.issue=2&rft.pages=393%E2%80%93396&rft_id=info:doi/10.1016%2FS0003-4975%2803%2901352-3&rft_id=info:pm id/14759403&rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-23"><b><a href="#cite_ref-23">^</a></b> <cite style="font-style:normal" class="" id="CITEREFGrant_AM.2C_Wileman_SM.2C_Ramsay_CR.2C_.27.27et_al..27.272008">Grant AM, Wileman SM, Ramsay CR, <i>et al.</i> (2008). "<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2603580" class="external text" title="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2603580" rel="nofollow">Minimal access surgery compared with medical management for chronic gastro-oesophageal reflux disease: UK collaborative randomised trial</a>". <i>BMJ</i> <b>337</b>: a2664. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19074946" class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/19074946">PMID 19074946</a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Minimal+ access+surgery+compared+with+medical+management+for+chronic+gastro-oesophageal+reflux+disease%3A+UK+collaborative+randomised+tr ial&rft.jtitle=BMJ&rft.aulast=Grant+AM%2C+Wileman+SM%2C+Ramsay+CR%2C+%27%27et+al.%27%27&rft.au=Grant+AM%2C+Wileman+ SM%2C+Ramsay+CR%2C+%27%27et+al.%27%27&rft.date=2008&rft.volume=337&rft.pages=a2664&rft_id=info:pmid/19074946&am p;rfr_id=info:sid/en.wikipedia.org:Gastroesophageal_reflux_disease"><span style="display: none;"> </span></span></li> <li id="cite_note-24"><b><a href="#cite_ref-24">^</a></b> <a href="http://www.cbsnews.com/stories/2009/01/16/health/main4728359.shtml?source=RSSattr=Health_4728359" class="external text" title="http://www.cbsnews.com/stories/2009/01/16/health/main4728359.shtml?source=RSSattr=Health_4728359" rel="nofollow">New Surgery For Acid Reflux Sufferers</a>. Retrieved on 2009-01-16.</li> </ol> </div> <p><a name="External_links" id="External_links"></a></p> <h2><span class="editsection">[<a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit&section=13" title="Edit section: External links">edit</a>]</span> <span class="mw-headline">External links</span></h2> <ul> <li><a href="http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/" class="external text" title="http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/" rel="nofollow">GERD patient information page</a> at <a href="/wiki/NIH" title="NIH" class="mw-redirect">NIH</a></li> <li><a href="http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/acidpeptic/acidpeptic.htm" class="external text" title="http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/acidpeptic/acidpeptic.htm" rel="nofollow">Overview</a> of acid peptic disorders from the Cleveland Clinic.</li> </ul> <table class="navbox" cellspacing="0" style=";"> <tr> <td style="padding:2px;"> <table cellspacing="0" class="nowraplinks collapsible collapsed" style="width:100%;background:transparent;color:inherit;;"> <tr> <th style=";background:silver;" colspan="2" class="navbox-title"> <div style="float:left; width:6em;text-align:left;"> <div class="noprint plainlinks navbar" style="background:none; padding:0; font-weight:normal;;background:silver;;border:none;; font-size:xx-small;"><a href="/wiki/Template:Digestive_system_diseases" title="Template:Digestive system diseases"><span title="View this template" style=";background:silver;;border:none;">v</span></a> <span style="font-size:80%;">•</span> <a href="/wiki/Template_talk:Digestive_system_diseases" title="Template talk:Digestive system diseases"><span title="Discuss this template" style=";background:silver;;border:none;">d</span></a> <span style="font-size:80%;">•</span> <a href="http://en.wikipedia.org/w/index.php?title=Template:Digestive_system_diseases&action=edit" class="external text" title="http://en.wikipedia.org/w/index.php?title=Template:Digestive_system_diseases&action=edit" rel="nofollow"><span title="Edit this template" style=";background:silver;;border:none;;">e</span></a></div> </div> <span class="" style="font-size:110%;"><a href="/wiki/Digestive_system" title="Digestive system" class="mw-redirect">Digestive system</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Digestive_disease" title="Digestive disease">Digestive disease</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a> (primarily <a href="/wiki/ICD-10_Chapter_XI:_Diseases_of_the_digestive_system" title="ICD-10 Chapter XI: Diseases of the digestive system">K20-K93</a>, <a href="/wiki/List_of_ICD-9_codes_520-579:_Diseases_of_the_digestive_system#diseases_of_esophagus.2C_stomach.2C_and_duodenum_.285 30-537.29" title="List of ICD-9 codes 520-579: Diseases of the digestive system" class="mw-redirect">530-579</a>)</span></th> </tr> <tr style="height:2px;"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Upper_alimentary_tract#Upper_gastrointestinal_tract" title="Upper alimentary tract" class="mw-redirect">Upper GI tract</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"></div> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Esophageal_disease" title="Esophageal disease">Esophagus</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Esophagitis" title="Esophagitis">Esophagitis</a> (<a href="/wiki/Esophageal_candidiasis" title="Esophageal candidiasis">Candidal</a>)<span style="font-weight:bold;"> ·</span> <i>rupture</i> (<a href="/wiki/Boerhaave_syndrome" title="Boerhaave syndrome">Boerhaave syndrome</a>, <a href="/wiki/Mallory-Weiss_syndrome" title="Mallory-Weiss syndrome">Mallory-Weiss syndrome</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Upper_esophageal_sphincter" title="Upper esophageal sphincter">UES</a> (<a href="/wiki/Zenker%27s_diverticulum" title="Zenker's diverticulum">Zenker's diverticulum</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Lower_esophageal_sphincter" title="Lower esophageal sphincter" class="mw-redirect">LES</a> (<a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Esophageal_motility_disorder" title="Esophageal motility disorder">Esophageal motility disorder</a> (<a href="/wiki/Nutcracker_esophagus" title="Nutcracker esophagus">Nutcracker esophagus</a>, <a href="/wiki/Achalasia" title="Achalasia">Achalasia</a>, <a href="/wiki/Diffuse_esophageal_spasm" title="Diffuse esophageal spasm">Diffuse esophageal spasm</a>, <strong class="selflink">GERD</strong>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Esophageal_stricture" title="Esophageal stricture">Esophageal stricture</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Megaesophagus" title="Megaesophagus">Megaesophagus</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Stomach_disease" title="Stomach disease">Stomach</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Gastritis" title="Gastritis">Gastritis</a> (<a href="/wiki/Atrophic_gastritis" title="Atrophic gastritis">Atrophic</a>, <a href="/wiki/M%C3%A9n%C3%A9trier%27s_disease" title="Ménétrier's disease">Ménétrier's disease</a>, <a href="/wiki/Gastroenteritis" title="Gastroenteritis">Gastroenteritis</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Peptic_ulcer" title="Peptic ulcer">Peptic (gastric) ulcer</a> (<a href="/wiki/Cushing_ulcer" title="Cushing ulcer">Cushing ulcer</a>, <a href="/wiki/Dieulafoy%27s_lesion" title="Dieulafoy's lesion">Dieulafoy's lesion</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Dyspepsia" title="Dyspepsia">Dyspepsia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Pyloric_stenosis" title="Pyloric stenosis">Pyloric stenosis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Achlorhydria" title="Achlorhydria">Achlorhydria</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastroparesis" title="Gastroparesis">Gastroparesis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastroptosis" title="Gastroptosis">Gastroptosis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Portal_hypertensive_gastropathy" title="Portal hypertensive gastropathy">Portal hypertensive gastropathy</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastric_antral_vascular_ectasia" title="Gastric antral vascular ectasia">Gastric antral vascular ectasia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastric_dumping_syndrome" title="Gastric dumping syndrome">Gastric dumping syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gastric_volvulus" title="Gastric volvulus">Gastric volvulus</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Intestinal_disease" title="Intestinal disease" class="mw-redirect">Intestinal</a>/<br /> <a href="/wiki/Enteropathy" title="Enteropathy">enteropathy</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"></div> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Small_intestine" title="Small intestine">Small intestine</a>/<br /> (<a href="/wiki/Duodenum" title="Duodenum">duodenum</a>/<a href="/wiki/Jejunum" title="Jejunum">jejunum</a>/<a href="/wiki/Ileum" title="Ileum">ileum</a>)</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Enteritis" title="Enteritis">Enteritis</a> (<a href="/wiki/Duodenitis" title="Duodenitis">Duodenitis</a>, <a href="/wiki/Jejunitis" title="Jejunitis" class="mw-redirect">Jejunitis</a>, <a href="/wiki/Ileitis" title="Ileitis">Ileitis</a>) — <a href="/wiki/Peptic_ulcer" title="Peptic ulcer">Peptic (duodenal) ulcer</a> (<a href="/wiki/Curling%27s_ulcer" title="Curling's ulcer">Curling's ulcer</a>) — <a href="/wiki/Malabsorption" title="Malabsorption">Malabsorption</a>: <a href="/wiki/Coeliac_disease" title="Coeliac disease">Coeliac</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Tropical_sprue" title="Tropical sprue">Tropical sprue</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Blind_loop_syndrome" title="Blind loop syndrome">Blind loop syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Whipple%27s_disease" title="Whipple's disease">Whipple's</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Short_bowel_syndrome" title="Short bowel syndrome">Short bowel syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Steatorrhea" title="Steatorrhea">Steatorrhea</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Milroy_disease" title="Milroy disease" class="mw-redirect">Milroy disease</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Large_intestine" title="Large intestine">Large intestine</a><br /> (<a href="/wiki/Vermiform_appendix" title="Vermiform appendix">appendix</a>/<a href="/wiki/Colon_(anatomy)" title="Colon (anatomy)">colon</a>)</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Appendicitis" title="Appendicitis">Appendicitis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Colitis" title="Colitis">Colitis</a> (<a href="/wiki/Pseudomembranous_colitis" title="Pseudomembranous colitis">Pseudomembranous</a>, <a href="/wiki/Ulcerative_colitis" title="Ulcerative colitis">Ulcerative</a>, <a href="/wiki/Ischemic_colitis" title="Ischemic colitis">Ischemic</a>, <a href="/wiki/Microscopic_colitis" title="Microscopic colitis">Microscopic</a>, <a href="/wiki/Collagenous_colitis" title="Collagenous colitis">Collagenous</a>, <a href="/wiki/Lymphocytic_colitis" title="Lymphocytic colitis">Lymphocytic</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Functional_colonic_disease" title="Functional colonic disease">Functional colonic disease</a> (<a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">IBS</a>, <a href="/wiki/Intestinal_pseudoobstruction" title="Intestinal pseudoobstruction">Intestinal pseudoobstruction</a>/<a href="/wiki/Ogilvie_syndrome" title="Ogilvie syndrome">Ogilvie syndrome</a>) — <a href="/wiki/Megacolon" title="Megacolon">Megacolon</a>/<a href="/wiki/Toxic_megacolon" title="Toxic megacolon">Toxic megacolon</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Diverticulitis" title="Diverticulitis">Diverticulitis</a>/<a href="/wiki/Diverticulosis" title="Diverticulosis">Diverticulosis</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;">Large and/or small</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Enterocolitis" title="Enterocolitis">Enterocolitis</a> (<a href="/wiki/Necrotizing_enterocolitis" title="Necrotizing enterocolitis">Necrotizing</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">IBD</a> (<a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a>) — <i><a href="/wiki/Vascular_disease" title="Vascular disease">vascular</a></i>: <a href="/wiki/Abdominal_angina" title="Abdominal angina">Abdominal angina</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Mesenteric_ischemia" title="Mesenteric ischemia">Mesenteric ischemia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Angiodysplasia" title="Angiodysplasia">Angiodysplasia</a> — <a href="/wiki/Bowel_obstruction" title="Bowel obstruction">Bowel obstruction</a>: <a href="/wiki/Ileus" title="Ileus">Ileus</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Intussusception_(medical_disorder)" title="Intussusception (medical disorder)">Intussusception</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Volvulus" title="Volvulus">Volvulus</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Fecal_impaction" title="Fecal impaction">Fecal impaction</a> — <a href="/wiki/Constipation" title="Constipation">Constipation</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Diarrhea" title="Diarrhea">Diarrhea</a> (<a href="/wiki/Infectious_diarrhea" title="Infectious diarrhea">Infectious</a>)</div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Rectum" title="Rectum">Rectum</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Proctitis" title="Proctitis">Proctitis</a> (<a href="/wiki/Radiation_proctitis" title="Radiation proctitis">Radiation proctitis</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Proctalgia_fugax" title="Proctalgia fugax">Proctalgia fugax</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Rectal_prolapse" title="Rectal prolapse">Rectal prolapse</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Human_anus" title="Human anus">Anus</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Anal_fissure" title="Anal fissure">Anal fissure</a>/<a href="/wiki/Anal_fistula" title="Anal fistula">Anal fistula</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Anal_abscess" title="Anal abscess">Anal abscess</a> <span style="font-weight:bold;"> ·</span> <a href="/wiki/Anal_dysplasia" title="Anal dysplasia">Anal dysplasia</a> <span style="font-weight:bold;"> ·</span> <a href="/wiki/Pruritus_ani" title="Pruritus ani">Pruritus ani</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Accessory_digestive_gland" title="Accessory digestive gland">Accessory</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"></div> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Liver_disease" title="Liver disease">Liver</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Hepatitis" title="Hepatitis">Hepatitis</a> (<a href="/wiki/Viral_hepatitis" title="Viral hepatitis">Viral hepatitis</a>, <a href="/wiki/Autoimmune_hepatitis" title="Autoimmune hepatitis">Autoimmune hepatitis</a>, <a href="/wiki/Alcoholic_hepatitis" title="Alcoholic hepatitis">Alcoholic hepatitis</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Cirrhosis" title="Cirrhosis">Cirrhosis</a> (<a href="/wiki/Primary_biliary_cirrhosis" title="Primary biliary cirrhosis">PBC</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Fatty_liver" title="Fatty liver">Fatty liver</a> (<a href="/wiki/Non-alcoholic_fatty_liver_disease" title="Non-alcoholic fatty liver disease">NASH</a>)<span style="font-weight:bold;"> ·</span> <i><a href="/wiki/Vascular_disease" title="Vascular disease">vascular</a></i> (<a href="/wiki/Hepatic_veno-occlusive_disease" title="Hepatic veno-occlusive disease">Hepatic veno-occlusive disease</a>, <a href="/wiki/Portal_hypertension" title="Portal hypertension">Portal hypertension</a>, <a href="/wiki/Nutmeg_liver" title="Nutmeg liver">Nutmeg liver</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Alcoholic_liver_disease" title="Alcoholic liver disease">Alcoholic liver disease</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Liver_failure" title="Liver failure">Liver failure</a> (<a href="/wiki/Hepatic_encephalopathy" title="Hepatic encephalopathy">Hepatic encephalopathy</a>, <a href="/wiki/Acute_liver_failure" title="Acute liver failure">Acute liver failure</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Liver_abscess" title="Liver abscess">Liver abscess</a> (<a href="/wiki/Pyogenic_liver_abscess" title="Pyogenic liver abscess">Pyogenic</a>, <a href="/wiki/Amoebic_liver_abscess" title="Amoebic liver abscess">Amoebic</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Hepatorenal_syndrome" title="Hepatorenal syndrome">Hepatorenal syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Peliosis_hepatis" title="Peliosis hepatis">Peliosis hepatis</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Gallbladder_disease" title="Gallbladder disease" class="mw-redirect">Gallbladder</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Cholecystitis" title="Cholecystitis">Cholecystitis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gallstone" title="Gallstone">Gallstones</a>/<a href="/wiki/Cholecystolithiasis" title="Cholecystolithiasis" class="mw-redirect">Cholecystolithiasis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Cholesterolosis_of_gallbladder" title="Cholesterolosis of gallbladder">Cholesterolosis</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Rokitansky-Aschoff_sinuses" title="Rokitansky-Aschoff sinuses">Rokitansky-Aschoff sinuses</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Postcholecystectomy_syndrome" title="Postcholecystectomy syndrome">Postcholecystectomy syndrome</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Bile_duct" title="Bile duct">Bile duct</a>/<br /> other <a href="/wiki/Biliary_tree" title="Biliary tree" class="mw-redirect">biliary tree</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Cholangitis" title="Cholangitis">Cholangitis</a> (<a href="/wiki/Primary_sclerosing_cholangitis" title="Primary sclerosing cholangitis">PSC</a>, <a href="/wiki/Secondary_sclerosing_cholangitis" title="Secondary sclerosing cholangitis">Secondary sclerosing cholangitis</a>, <a href="/wiki/Ascending_cholangitis" title="Ascending cholangitis">Ascending</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Cholestasis" title="Cholestasis">Cholestasis</a>/<a href="/wiki/Mirizzi%27s_syndrome" title="Mirizzi's syndrome">Mirizzi's syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Biliary_fistula" title="Biliary fistula">Biliary fistula</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Haemobilia" title="Haemobilia">Haemobilia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Gallstone" title="Gallstone">Gallstones</a>/<a href="/wiki/Cholelithiasis" title="Cholelithiasis" class="mw-redirect">Cholelithiasis</a><br /> <i><a href="/wiki/Common_bile_duct" title="Common bile duct">common bile duct</a></i> (<a href="/wiki/Choledocholithiasis" title="Choledocholithiasis">Choledocholithiasis</a>, <a href="/wiki/Biliary_dyskinesia" title="Biliary dyskinesia">Biliary dyskinesia</a>)</div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: #fd6;"> <div style="padding:0em 0.75em;"><a href="/wiki/Pancreatic_disease" title="Pancreatic disease">Pancreatic</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Pancreatitis" title="Pancreatitis">Pancreatitis</a> (<a href="/wiki/Acute_pancreatitis" title="Acute pancreatitis">Acute</a>, <a href="/wiki/Chronic_pancreatitis" title="Chronic pancreatitis">Chronic</a>, <a href="/wiki/Hereditary_pancreatitis" title="Hereditary pancreatitis">Hereditary</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Pancreatic_pseudocyst" title="Pancreatic pseudocyst">Pancreatic pseudocyst</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Exocrine_pancreatic_insufficiency" title="Exocrine pancreatic insufficiency">Exocrine pancreatic insufficiency</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Pancreatic_fistula" title="Pancreatic fistula">Pancreatic fistula</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Hernia" title="Hernia">Hernia</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Diaphragmatic_hernia" title="Diaphragmatic hernia">Diaphragmatic</a>: <a href="/wiki/Congenital_diaphragmatic_hernia" title="Congenital diaphragmatic hernia">Congenital diaphragmatic</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Hiatus_hernia" title="Hiatus hernia">Hiatus</a> — <a href="/wiki/Abdominal_hernia" title="Abdominal hernia" class="mw-redirect">Abdominal hernia</a>: <a href="/wiki/Inguinal_hernia" title="Inguinal hernia">Inguinal</a> (<a href="/wiki/Indirect_inguinal_hernia" title="Indirect inguinal hernia">Indirect</a>, <a href="/wiki/Direct_inguinal_hernia" title="Direct inguinal hernia">Direct</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Umbilical_hernia" title="Umbilical hernia">Umbilical</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Incisional_hernia" title="Incisional hernia">Incisional</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Femoral_hernia" title="Femoral hernia">Femoral</a> — <a href="/wiki/Obturator_hernia" title="Obturator hernia">Obturator hernia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Spigelian_hernia" title="Spigelian hernia">Spigelian hernia</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Internal_hernia" title="Internal hernia">Internal hernia</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Peritoneal_disease" title="Peritoneal disease" class="mw-redirect">Peritoneal</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/wiki/Peritonitis" title="Peritonitis">Peritonitis</a> (<a href="/wiki/Spontaneous_bacterial_peritonitis" title="Spontaneous bacterial peritonitis">Spontaneous bacterial peritonitis</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Hemoperitoneum" title="Hemoperitoneum">Hemoperitoneum</a><span style="font-weight:bold;"> ·</span> <a href="/wiki/Pneumoperitoneum" title="Pneumoperitoneum">Pneumoperitoneum</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:#fd6;;"><a href="/wiki/Gastrointestinal_bleeding" title="Gastrointestinal bleeding">GI bleeding</a>/<a href="/wiki/Blood_in_stool" title="Blood in stool">BIS</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/wiki/Upper_gastrointestinal_bleeding" title="Upper gastrointestinal bleeding">Upper</a> (<a href="/wiki/Hematemesis" title="Hematemesis">Hematemesis</a>, <a href="/wiki/Melena" title="Melena">Melena</a>)<span style="font-weight:bold;"> ·</span> <a href="/wiki/Lower_gastrointestinal_bleeding" title="Lower gastrointestinal bleeding">Lower</a> (<a href="/wiki/Hematochezia" title="Hematochezia">Hematochezia</a>)</div> </td> </tr> <tr style="height:2px;"> <td></td> </tr> <tr> <td class="navbox-abovebelow" style=";" colspan="2"> <div class="rellink boilerplate seealso">See also: <a href="/wiki/Template:Congenital_malformations_and_deformations_of_digestive_system" title="Template:Congenital malformations and deformations of digestive system">congenital</a> and <a href="/wiki/Template:Digestive_system_neoplasia" title="Template:Digestive system neoplasia">neoplasia</a></div> </td> </tr> </table> </td> </tr> </table>   <div class="printfooter"> Retrieved from "<a href="http://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease">http://en.wikipedia.org/wiki/Gastroesophageal_reflux_diseas e</a>"</div> <div id='catlinks' class='catlinks'><div id="mw-normal-catlinks"><a href="/wiki/Special:Categories" title="Special:Categories">Categories</a>: <span dir='ltr'><a href="/wiki/Category:Digestive_diseases" title="Category:Digestive diseases">Digestive diseases</a></span> | <span dir='ltr'><a href="/wiki/Category:General_practice" title="Category:General practice">General practice</a></span> | <span dir='ltr'><a href="/wiki/Category:Medical_conditions_related_to_obesity" title="Category:Medical conditions related to obesity">Medical conditions related to obesity</a></span></div><div id="mw-hidden-catlinks" class="mw-hidden-cats-hidden">Hidden categories: <span dir='ltr'><a href="/wiki/Category:All_articles_with_unsourced_statements" title="Category:All articles with unsourced statements">All articles with unsourced statements</a></span> | <span dir='ltr'><a href="/wiki/Category:Articles_with_unsourced_statements_from_March_2009" title="Category:Articles with unsourced statements from March 2009">Articles with unsourced statements from March 2009</a></span> | <span dir='ltr'><a href="/wiki/Category:Articles_with_unsourced_statements_from_June_2009" title="Category:Articles with unsourced statements from June 2009">Articles with unsourced statements from June 2009</a></span> | <span dir='ltr'><a href="/wiki/Category:Articles_with_unsourced_statements_from_January_2009" title="Category:Articles with unsourced statements from January 2009">Articles with unsourced statements from January 2009</a></span></div></div>  <div class="visualClear"></div> </div> </div> </div> <div id="column-one"> <div id="p-cactions" class="portlet"> <h5>Views</h5> <div class="pBody"> <ul lang="en" xml:lang="en"> <li id="ca-nstab-main" class="selected"><a href="/wiki/Gastroesophageal_reflux_disease" title="View the content page [c]" accesskey="c">Article</a></li> <li id="ca-talk"><a href="/wiki/Talk:Gastroesophageal_reflux_disease" title="Discussion about the content page [t]" accesskey="t">Discussion</a></li> <li id="ca-edit"><a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=edit" title="You can edit this page. 
Please use the preview button before saving. [e]" accesskey="e">Edit this page</a></li> <li id="ca-history"><a href="/w/index.php?title=Gastroesophageal_reflux_disease&action=history" title="Past versions of this page [h]" accesskey="h">History</a></li> </ul> </div> </div> <div class="portlet" id="p-personal"> <h5>Personal tools</h5> <div class="pBody"> <ul lang="en" xml:lang="en"> <li id="pt-acaibeta"><a href="http://en.wikipedia.org/w/index.php?title=Special:UsabilityInitiativeOptIn&from=Gastroesophageal_reflux_disease" class="no-text-transform">Try Beta</a></li> <li id="pt-login"><a href="/w/index.php?title=Special:UserLogin&returnto=Gastroesophageal_reflux_disease" title="You are encouraged to log in; however, it is not mandatory. [o]" accesskey="o">Log in / create account</a></li> </ul> </div> </div> <div class="portlet" id="p-logo"> <a style="background-image: url(http://upload.wikimedia.org/wikipedia/en/b/bc/Wiki.png);" href="/wiki/Main_Page" title="Visit the main page [z]" accesskey="z"></a> </div> <script type="text/javascript"> if (window.isMSIE55) fixalpha(); </script> <div class='generated-sidebar portlet' id='p-navigation'> <h5 lang="en" xml:lang="en">Navigation</h5> <div class='pBody'> <ul> <li id="n-mainpage-description"><a href="/wiki/Main_Page" title="Visit the main page [z]" accesskey="z">Main page</a></li> <li id="n-contents"><a href="/wiki/Portal:Contents" title="Guides to browsing Wikipedia">Contents</a></li> <li id="n-featuredcontent"><a href="/wiki/Portal:Featured_content" title="Featured content — the best of Wikipedia">Featured content</a></li> <li id="n-currentevents"><a href="/wiki/Portal:Current_events" title="Find background information on current events">Current events</a></li> <li id="n-randompage"><a href="/wiki/Special:Random" title="Load a random article [x]" accesskey="x">Random article</a></li> </ul> </div> </div> <div id="p-search" class="portlet"> <h5 lang="en" xml:lang="en"><label for="searchInput">Search</label></h5> <div id="searchBody" class="pBody"> <form action="/w/index.php" id="searchform"><div> <input type='hidden' name="title" value="Special:Search"/> <input id="searchInput" name="search" type="text" title="Search Wikipedia [f]" accesskey="f" value="" /> <input type='submit' name="go" class="searchButton" id="searchGoButton" value="Go" title="Go to a page with this exact name if one exists" />  <input type='submit' name="fulltext" class="searchButton" id="mw-searchButton" value="Search" title="Search Wikipedia for this text" /> </div></form> </div> </div> <div class='generated-sidebar portlet' id='p-interaction'> <h5 lang="en" xml:lang="en">Interaction</h5> <div class='pBody'> <ul> <li id="n-aboutsite"><a href="/wiki/Wikipedia:About" title="Find out about Wikipedia">About Wikipedia</a></li> <li id="n-portal"><a href="/wiki/Wikipedia:Community_portal" title="About the project, what you can do, where to find things">Community portal</a></li> <li id="n-recentchanges"><a href="/wiki/Special:RecentChanges" title="The list of recent changes in the wiki [r]" accesskey="r">Recent changes</a></li> <li id="n-contact"><a href="/wiki/Wikipedia:Contact_us" title="How to contact Wikipedia">Contact Wikipedia</a></li> <li id="n-sitesupport"><a href="http://wikimediafoundation.org/wiki/Donate/Now/en?utm_source=donate&utm_medium=sidebar&utm_campaign=spontaneous_d onation" title="Support us">Donate to Wikipedia</a></li> <li id="n-help"><a href="/wiki/Help:Contents" title="Guidance on how to use and edit Wikipedia">Help</a></li> </ul> </div> </div> <div class="portlet" id="p-tb"> <h5 lang="en" xml:lang="en">Toolbox</h5> <div class="pBody"> <ul> <li id="t-whatlinkshere"><a href="/wiki/Special:WhatLinksHere/Gastroesophageal_reflux_disease" title="List of all English Wikipedia pages containing links to this page [j]" accesskey="j">What links here</a></li> <li id="t-recentchangeslinked"><a href="/wiki/Special:RecentChangesLinked/Gastroesophageal_reflux_disease" title="Recent changes in pages linked from this page [k]" accesskey="k">Related changes</a></li> <li id="t-upload"><a href="/wiki/Wikipedia:Upload" title="Upload files [u]" accesskey="u">Upload file</a></li> <li id="t-specialpages"><a href="/wiki/Special:SpecialPages" title="List of all special pages [q]" accesskey="q">Special pages</a></li> <li id="t-print"><a href="/w/index.php?title=Gastroesophageal_reflux_disease&printable=yes" rel="alternate" title="Printable version of this page [p]" accesskey="p">Printable version</a></li> <li id="t-permalink"><a href="/w/index.php?title=Gastroesophageal_reflux_disease&oldid=306489498" title="Permanent link to this revision of the page">Permanent link</a></li><li id="t-cite"><a href="/w/index.php?title=Special:Cite&page=Gastroesophageal_reflux_disease&id=306489498">Cite this page</a></li> </ul> </div> </div> <div id="p-lang" class="portlet"> <h5 lang="en" xml:lang="en">Languages</h5> <div class="pBody"> <ul> <li class="interwiki-az"><a href="http://az.wikipedia.org/wiki/Qastro-ezofageal_reflyuks_x%C9%99st%C9%99liyi">Azərbaycan</a></li> <li class="interwiki-bs"><a href="http://bs.wikipedia.org/wiki/Gastroezofagealna_refluksna_bolest">Bosanski</a></li> <li class="interwiki-cs"><a href="http://cs.wikipedia.org/wiki/Gastroezofage%C3%A1ln%C3%AD_reflux">Česky</a></li> <li class="interwiki-de"><a href="http://de.wikipedia.org/wiki/Reflux%C3%B6sophagitis">Deutsch</a></li> <li class="interwiki-el"><a href="http://el.wikipedia.org/wiki/%CE%93%CE%B1%CF%83%CF%84%CF%81%CE%BF%CE%BF%CE%B9%CF%83%CE%BF%CF%86%CE%B1%CE%B3%CE%B9%CE%BA%C E%AE_%CF%80%CE%B1%CE%BB%CE%B9%CE%BD%CE%B4%CF%81%CE%BF%CE%BC%CE%B9%CE%BA%CE%AE_%CE%BD%CF%8C%CF%83%CE%BF%CF%82">Ελληνικά< /a></li> <li class="interwiki-fr"><a href="http://fr.wikipedia.org/wiki/Reflux_gastro-%C5%93sophagien">Français</a></li> <li class="interwiki-hi"><a href="http://hi.wikipedia.org/wiki/%E0%A4%8F%E0%A4%B8%E0%A4%BF%E0%A4%A1%E0%A4%BF%E0%A4%9F%E0%A5%80">हिन्दी</a></li> <li class="interwiki-hr"><a href="http://hr.wikipedia.org/wiki/Gastroezofagealna_refluksna_bolest">Hrvatski</a></li> <li class="interwiki-it"><a href="http://it.wikipedia.org/wiki/Malattia_da_reflusso_gastroesofageo">Italiano</a></li> <li class="interwiki-he"><a href="http://he.wikipedia.org/wiki/%D7%A8%D7%A4%D7%9C%D7%95%D7%A7%D7%A1_%D7%A7%D7%99%D7%91%D7%AA%D7%99_%D7%95%D7%A9%D7%98%D7%99 ">עברית</a></li> <li class="interwiki-ja"><a href="http://ja.wikipedia.org/wiki/%E9%80%86%E6%B5%81%E6%80%A7%E9%A3%9F%E9%81%93%E7%82%8E">日本語</a></li> <li class="interwiki-la"><a href="http://la.wikipedia.org/wiki/Oesophagitis_propter_reflux">Latina</a></li> <li class="interwiki-nl"><a href="http://nl.wikipedia.org/wiki/Oesofagale_reflux">Nederlands</a></li> <li class="interwiki-no"><a href="http://no.wikipedia.org/wiki/Gastro%C3%B8sofageal_refluks">‪Norsk (bokmål)‬</a></li> <li class="interwiki-pl"><a href="http://pl.wikipedia.org/wiki/Refluks_%C5%BCo%C5%82%C4%85dkowo-prze%C5%82ykowy">Polski</a></li> <li class="interwiki-pt"><a href="http://pt.wikipedia.org/wiki/Refluxo_gastroesof%C3%A1gico">Português</a></li> <li class="interwiki-ru"><a href="http://ru.wikipedia.org/wiki/%D0%93%D0%B0%D1%81%D1%82%D1%80%D0%BE%D1%8D%D0%B7%D0%BE%D1%84%D0%B0%D0%B3%D0%B5%D0%B0%D0%BB%D 1%8C%D0%BD%D0%B0%D1%8F_%D1%80%D0%B5%D1%84%D0%BB%D1%8E%D0%BA%D1%81%D0%BD%D0%B0%D1%8F_%D0%B1%D0%BE%D0%BB%D0%B5%D0%B7%D0%BD%D1%8C" >Русский</a></li> <li class="interwiki-sv"><a href="http://sv.wikipedia.org/wiki/Gastroesofageal_refluxsjukdom">Svenska</a></li> <li class="interwiki-th"><a href="http://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B8%81%E0%B8%A3%E0%B8%94%E0%B9%84%E0%B8%AB%E0%B8%A5%E0%B8%A2%E 0%B9%89%E0%B8%AD%E0%B8%99">ไทย</a></li> <li class="interwiki-tr"><a href="http://tr.wikipedia.org/wiki/Refl%C3%BC">Türkçe</a></li> <li class="interwiki-zh"><a href="http://zh.wikipedia.org/wiki/%E8%83%83%E9%A3%9F%E7%AE%A1%E5%8F%8D%E6%B5%81%E7%97%85">中文</a></li> </ul> </div> </div> </div> <div class="visualClear"></div> <div id="footer"> <div id="f-poweredbyico"><a href="http://www.mediawiki.org/"><img src="/skins-1.5/common/images/poweredby_mediawiki_88x31.png" alt="Powered by MediaWiki" /></a></div> <div id="f-copyrightico"><a href="http://wikimediafoundation.org/"><img src="/images/wikimedia-button.png" alt="Wikimedia Foundation"/></a></div> <ul id="f-list"> <li id="lastmod"> This page was last modified on 6 August 2009 at 22:28.</li> <li id="copyright">Text is available under the <a href="http://en.wikipedia.org/wiki/Wikipedia:Text_of_Creative_Commons_Attribution-ShareAlike_3.0_Unported_License">Creative Commons Attribution/Share-Alike License</a>; additional terms may apply. See <a href="http://wikimediafoundation.org/wiki/Terms_of_Use">Terms of Use</a> for details.<br/> Wikipedia® is a registered trademark of the <a href="http://www.wikimediafoundation.org/">Wikimedia Foundation, Inc.</a>, a non-profit organization.</li> <li id="privacy"><a href="http://wikimediafoundation.org/wiki/Privacy_policy" class="extiw" title="wikimedia:Privacy policy">Privacy policy</a></li> <li id="about"><a href="/wiki/Wikipedia:About" title="Wikipedia:About">About Wikipedia</a></li> <li id="disclaimer"><a href="/wiki/Wikipedia:General_disclaimer" title="Wikipedia:General disclaimer">Disclaimers</a></li> </ul> </div> </div> <script type="text/javascript">if (window.runOnloadHook) runOnloadHook();</script> ge was last modified on 6 August 2009 at 22:28.</li> <li id="copyright">Text is available under the <a href="http://en.wikipedia.org/wiki/Wikipedia:Text_of_Creative_Commons_Attribution-ShareAlike_3.0_Unported_License">Creative Commons Attribution/Share-Alike License</a>; additional terms may apply. See <a href="http://wikimediafoundation.org/wiki/Terms_of_Use">Terms of Use</a> for details.<br/> Wikipedia® is a registered trademark of the <a href="http://www.wikimediafoundation.org/">Wikimedia Foundation, Inc.</a>, a non-profit organization.</li> <li id="privacy"><a href="http://wikimediafoundation.org/wiki/Privacy_policy" class="extiw" title="wikimedia:Privacy policy">Privacy policy</a></li> <li id="about"><a href="/wiki/Wikipedia:About" title="Wikipedia:About">About Wikipedia</a></li> <li id="disclaimer"><a href="/wiki/Wikipedia:General_disclaimer" title="Wikipedia:General disclaimer">Disclaimers</a></li> </ul> </div> </div> <script type="text/javascript">if (window.runOnloadHook) runOnloadHook();</script>