Gastro-Esophageal Reflux (GERD)

Introduction

Gastroesophageal reflux disease (GERD) is a relatively common symptom in peritoneal dialysis (PD) patients(1–3). However, there are conflicting data concerning the effects of increased intra-abdominal pressure on reflux. For instance, one study found no difference in lower esophageal sphincter pressures between symptomatic and asymptomatic patients while in the sitting position after a 1-2 liter infusion of dialysate. Yet, the same study also noted significantly lower pressures in symptomatic patients while in the supine position after a 2-liter infusion(4). Another study of 61 PD patients found that the incidence of GERD was not correlated with elevated daytime or nighttime intraperitoneal pressure (5).

Treatment and Preventative Measures

Small frequent meals and avoidance of foods that reduce sphincter pressure (e.g., chocolate and alcohol) are generally recommended. Pharmacologic agents for acid suppression may also be needed(6). Reducing exchange volume while standing or sitting is often beneficial.

References

  1. Strid H, Fjell A, Simrén M, Björnsson ES. Impact of dialysis on gastroesophageal reflux, dyspepsia, and proton pump inhibitor treatment in patients with chronic renal failure. Eur J Gastroenterol Hepatol. 2009;21(2):137-142. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19212202.
  2. Cekin AH, Boyacioglu S, Gursoy M, Bilezikci B, Gur G, Akin ED, Ozdemir N, Yilmaz U. Gastroesophageal reflux disease in chronic renal failure patients with upper GI symptoms: multivariate analysis of pathogenetic factors. Am J Gastroenterol. 2002;97(6):1352-1356. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12094849.
  3. Anderson JE, Yim KB, Crowell MD. Prevalence of gastroesophageal reflux disease in peritoneal dialysis and hemodialysis patients. Adv Perit Dial. 1999;15:75-78. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10682075.
  4. Kim MJ, Kwon KH, Lee SW. Gastroesophageal reflux disease in CAPD patients. Adv Perit Dial. 1998;14:98-101. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10649702.
  5. Dejardin A, Robert A, Goffin E. Intraperitoneal pressure in PD patients: relationship to intraperitoneal volume, body size and PD-related complications. Nephrol Dial Transplant. 2007;22(5):1437-1444. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17308323.
  6. Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, Johnson SP, Allen J, Brill J V, American Gastroenterological Association. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135(4):1383-1391, 1391.e1-e5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18789939.

The information and reference materials contained in this document are intended solely for the general education of the reader. It is intended to provide pertinent data to assist you in forming your own conclusions and making decisions. This document should not be considered an endorsement of the information provided nor is it intended for treatment purposes and is not a substitute for professional evaluation and diagnosis. Additionally, this information is not intended to advocate any indication, dosage or other claim that is not covered, if applicable, in the FDA-approved label.

P/N 102506-01 Rev.A 06/2016