GASTROENTEROLOGY
Etiology
Lower esophageal sphincter (LES) incompetence
Hiatal hernia
Obesity, pregnancy
Drugs (CCBs, nitrates, anticholinergics)
Lifestyle factors (alcohol, caffeine, smoking)
Pathogenesis
Transient LES relaxation → acid reflux → mucosal injury
Impaired esophageal clearance
Increased gastric volume/pressure
Diagnosis
Clinical symptoms (heartburn, regurgitation)
Upper endoscopy (if alarm symptoms)
24-hr pH monitoring (gold standard)
Treatment
Lifestyle modification
PPIs (first line)
H2 blockers
Antireflux surgery (Nissen fundoplication)