Gastroesophageal reflux disease GERD

Gastroesophageal reflux disease

Overview
gastroesophageal reflux disease

Gastroesophageal reflux disease When we eat food, it travels to the food pipe (esophagus) through the mouth and then to the stomach. Once in the stomach, food cannot return to the esophagus under normal conditions due to the presence of the lower esophageal sphincter (LES).

LES is a group of fiber muscle rings at the lower end of the food pipe that acts as a one-way valve.

It is tightly restricted in normal condition and only opens or relaxes when we swallow food.

When the sphincter becomes incompetent or does not close properly, the acidic contents of the stomach leak into the esophagus.

This condition is known as reflux and can irritate and damage the esophagus ‘ inner lining leading to gastroesophageal reflux disease (GERD) or acid reflux disease.

Population-based studies have shown that up to 15 percent of individuals have reflux symptoms at least once a week and 7 percent have symptoms daily.

Causes of Gastroesophageal reflux diseaseGERD

  • Decreased tone of LES is the main reason for Gastroesophageal reflux disease GERD.
    • It can occur due to excessive smoking,  alcohol consumption, caffeine intake and disease called scleroderma.
    • Various medications also cause or worsen GERD important one  are – nitrates, calcium channel blockers, progestin
  • Conditions that increase the overall stomach volume and pressure can cause GERD like large meals, pregnancy, obesity, fluid accumulation inside the abdomen, and tight clothing, bending over can also lead to GERD.
  • A hiatal hernia, a condition in which part of the stomach moves above the diaphragm, a muscle that separates the chest and abdominal cavities) can also lead to reflux.  

What are the symptoms of GERD?

  • heartburn or a burning pain in the chest,
  • feeling that food is stuck behind the breastbone after it is swallowed and
  • nausea after eating.
  • the bringing up of the food into the mouth or regurgitation can cause sourness in the mouth.
  • reflux of the stomach contents into the throat and respiratory passage can cause cough, pharyngitis, bronchitis and pneumonia.
  • difficulty in swallowing the food, hiccups, hoarseness or change in voice, excessive belching and sore throat are other common symptoms of GERD.
  • severe Gastroesophageal reflux disease GERD can lead to erosions in the inner lining of the esophagus which can cause bleeding.

Complication of GERD

  • Narrowing of the food pipe by strictures. Repeated burning of the lining of the stomach leads to scar formation that can narrow the foodpipe causing food to get stuck.
  • Development of esophageal ulcer from severe damage to the lining by the acid. It can bleed and cause pain during swallowing.
  • Development of Barrett’s esophagus which increases the risk of cancer and needs endoscopy to monitor the progression of the disease.

How is GERD diagnosed?

Gastroesophageal reflux disease GERD is diagnosed based on patient-reported signs and symptoms. Health care providers may consider additional diagnoses when symptoms become complicated or persist for a long time, or there is no response to therapy.

In such cases, an endoscopy may be performed that helps visualize the inner lining of the esophagus, stomach, and small intestine by inserting a small camera down the throat.

Esophageal manometry is another test used to measure the pressure inside the lower part of the esophagus.

How is GERD treated?

The goal of the treatment is to provide relief from symptoms and, if any, to heal erosive lesions and complications.

Mild symptoms can be managed by weight reduction, sleeping with the head of the bed elevated by about 4 – 6 inches and eliminating the factors that increase the pressure of the stomach.

Patients should not smoke and should avoid consuming fatty foods, coffee, chocolate, alcohol, mint, orange juice and certain medicines such as aspirin, ibuprofen, naproxen, anticholinergic agents, calcium channel blockers and smooth muscle relaxants.

You should avoid eating heavy meals and consuming a lot of meal liquids. Acetaminophen and paracetamol are preferred painkillers for those suffering from Gastroesophageal reflux disease GERD.

Health care providers may use drugs such as cimetidine and ranitidine to treat mild cases of acid reflux disease. These drugs help to reduce the secretion of acid in the stomach. Proton pump inhibitors such as pantoprazole, omeprazole, lansoprazole, and esomeprazole are useful in relieving symptoms and are commonly used in combination with counter antacid syrups.

Patients are advised to take these medicines 15-30 minutes before daily meals. Healthcare providers may recommend anti-reflux surgery for patients with persistent symptoms even after lifestyle and medicine changes.

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