Gastroesophageal Reflux Disease

Abstract Gastroesophageal reflux disease (GERD) is a highly prevalent condition that affects at least 20% of the general North American population and carries a heavy economic burden. Many patients with GERD present with noncardiac chest pain (NCCP), a chronic pain disorder that significantly contributes to poor quality of life and increased economic burden. The pathophysiology of NCCP, though poorly understood, is likely secondary to central sensitization. After ruling out cardiac causes of chest pain, a proton pump inhibitor trial can be diagnostic, while other diagnostic modalities can exclude esophageal disorders such as achalasia or the presence of strictures or malignancy. Primary treatment consists of lifestyle modifications and proton pump inhibitor therapy. Further interventions include pharmacologic neuromodulators, advanced procedures, surgery, and alternative therapies such as cognitive-behavioral therapy.