Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a chronic digestive ailment marked by frequent acid reflux, in which stomach acid runs back into the esophagus. If left untreated, this acid reflux can cause inflammation, irritation, and damage to the esophageal lining, resulting in a variety of symptoms and consequences.

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

Causes and Risk Factors

The lower esophageal sphincter (LES), a ring of muscle at the intersection of the esophagus and stomach, is principally responsible for GERD. Normally, the LES prevents stomach contents from flowing back into the esophagus by acting as a barrier. In GERD patients, however, the LES is weakened or relaxes in an abnormal manner, allowing stomach acid to reflux into the esophagus.

GERD risk factors include:

• Obesity
• Pregnancy
• Hernia of the hiatus
• Smoking
• Alcoholic beverages
• Some pharmaceuticals (e.g., calcium channel blockers, nitrates, antihistamines)
• Delay in gastric emptying

Indicators

Common GERD symptoms include:

• Heartburn is a sense of burning in the chest or throat.
• The sensation of acid backing up into the throat or mouth is known as regurgitation.
• Trouble swallowing
• Chest pain
• persistent cough
• Hoarseness or throat pain
• A sensation of a lump in one's throat
• Nausea

Diagnose

Typically, GERD is diagnosed using a combination of medical history, physical exam, and diagnostic tests. These tests may consist of:

Upper gastrointestinal (endoscopy): A procedure in which an endoscope is placed through the mouth to examine the esophagus, stomach, and upper portion of the small intestine. This enables the physician to detect any esophageal lining inflammation, erosion, or other abnormalities.

Esophageal pH monitoring is a 24-hour test that examines the acidity levels in the esophagus. This facilitates the determination of the frequency and severity of acid reflux episodes.

Esophageal manometry is a technique used to evaluate the functionality of the esophageal muscles, particularly the LES, by measuring their pressure and synchronization.

Barium swallow: An X-ray examination of the esophagus and stomach in which the patient ingests a barium-containing liquid that coats the digestive tract and makes it visible on the X-ray images.

Therapy

GERD is often treated with a mix of lifestyle adjustments, drugs, and, in extreme situations, surgery.

Changes in Lifestyle

• Weight loss if overweight or obese
• Avoiding trigger foods and beverages, such as hot and fatty foods, chocolate, caffeine, and alcohol.
• Eating more frequent, smaller meals
• Not lying down within two to three hours after a meal
• Increasing the height of the head of the bed by 6 to 8 inches to reduce overnight reflux.
• Stopping smoking

Pharmaceuticals

Antacids available over-the-counter to neutralize gastric acid To minimize acid production, H2 receptor blockers such as ranitidine or famotidine are used. Proton pump inhibitors (PPIs), such as omeprazole and esomeprazole, suppress the formation of stomach acid more efficiently than H2 blockers.

Surgery

In extreme cases of gastroesophageal reflux disease or when medical treatments fail to alleviate symptoms adequately, surgical intervention may be required. Fundoplication is the most common surgical treatment for GERD, in which the upper portion of the stomach is wrapped around the lower esophagus to strengthen the LES and prevent acid reflux.

Complications

Untreated GERD can result in a variety of problems, including:

• Esophagitis is the inflammation of the esophagus that results from frequent exposure to stomach acid.
• Esophageal stricture is a narrowing of the esophagus that can make swallowing challenging.
• Barrett's esophagus is a disorder in which the cells lining the lower esophagus transform into a new kind, hence raising the risk of esophageal cancer.
• Esophageal carcinoma is an uncommon but dangerous consequence of chronic GERD.

Also see

• Acid reflux
• Heartburn
• Barrett's esophagus
• Esophageal cancer
• Upper gastrointestinal endoscopy

External links

• NIH GERD patient information page
• Esophagitis Candida (yeast) infections
• KidsHealth GERD Information for Kids
• Cleveland Clinic
• GERD baby/child information page

Gastroesophageal reflux disease Resources
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