Gastroesophageal reflux disease

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Gastroesophageal reflux disease (GERD) is a serious form of gastroesophageal reflux (GER) . GER, also called acid reflux or regurgitation, occurs when stomach acid or bile flows back into the esophagus. When the acids or digestive juices touch the esophagus lining, it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common. When reflux occurs more than twice each week, it is termed GERD. People with GERD may need stronger medications to reduce their symptoms.

Contents

Causes

When a person swallows, the lower esophageal sphincter (LES) relaxes so food can flow down into the stomach and closes afterwards. If the LES weakens or performs abnormally, digestive juices can flow up into the esophagus. Frequent backwash of acid can irritate the esophagus lining.

A hiatal hernia may contribute to GERD. This condition occurs when part of the stomach protrudes into the chest through the diaphragm. The diaphragm helps the LES in keeping acid from going up into the esophagus. With a hiatal hernia, acid reflux may occur more easily.

Foods that can worsen symptoms of acid reflux are chocolate, drinks with caffeine or alcohol, garlic, onions, citrus fruits, spicy food, fatty and fried food, tomato-based foods such as spaghetti sauce, or chili.

Risk factors

The following conditions can increase the risk of GERD:

Symptoms

Frequent heartburn is the most common symptom of GERD. The burning-type sensation can be felt on the lower part of the mid-chest, behind the breast bone or in the mid-stomach. One can experience GERD without feeling heartburn. Other symptoms include asthma symptoms, dry cough, difficulty swallowing, sore throat, acid reflux or a feeling of a lump in the throat.

Diagnosis and tests

If GERD symptoms do not improve with a change in lifestyle or medication, additional tests may be recommended by a doctor.

  • Barium swallow radiograph or upper GI series. This X-ray test is used to find anatomical abnormalities in the upper digestive system such as the hiatal hernia. A patient is asked to drink a liquid that coats and fills hollow spots in his digestive track. This coating helps the doctor see the shape and condition of the esophagus, stomach and upper intestine.
  • Upper endoscopy. In this procedure a doctor passes a flexible tube with a light and camera called an endoscope down the patient's throat. With a small camera on the end, the doctor will be able to search the esophagus and stomach for abnormalities.
  • Biopsy. Forceps can be passed through the endoscope so the doctor can remove tissue from the esophagus. The tissue is examined further to look for damage from acid reflux or other problems like infection or abnormal growths.
  • pH monitoring. A small tube is inserted into the esophagus and stays for 24-48 hours. The device measures how much acid comes up the esophagus. The analysis can be more effective if the patient fills in a food diary. Correlations between symptoms and reflux episodes might be more clearly seen if the diary is completed carefully.
  • Esophageal impedance. This test measures the movement and pressure in the esophagus. A catheter is passed from the nose into the esophagus.

Treatment

Treatment of GERD depends on how severe the condition is.

Lifestyle changes

The incidence of GERD can be minimized with the following lifestyle changes:

  • Stopping smoking.
  • Avoiding foods and drinks that worsen symptoms.
  • Eating small, frequent meals.
  • Wearing loose-fitting clothes.
  • Avoiding lying down immediately two to three hours after a meal.

Medications

  • Antacids are the usual drugs recommended for heartburn relief. Many antacid brands contain a combination of magnesium, calcium, and aluminium with hydroxide or bicarbonate ions to neutralize stomach acid.
  • Calcium carbonate antacids can be a supplemental source of calcium.
  • Foaming agents coat the stomach with foam to prevent acid reflux.
  • H2 blockers decrease acid production.
  • Proton pump inhibitors can relieve symptoms and heal the esophageal lining.
  • Prokinetics help empty the stomach faster and make the LES stronger.

Combinations of medications may be recommended by doctors to help control symptoms.

Surgery

When lifestyle changes and medications do little to minimize GERD symptoms, surgery may be recommended.

  • Fundoplication. This is the standard surgical treatment for GERD. Nissen fundoplication is a specific type of this procedure that involves wrapping the upper part of the stomach around the LES. This helps strengthen the sphincter, prevent reflux or repair a hiatal hernia.
  • Endoscopic techniques. This may include the Bard EndoCinch system, NDO Plicator, and the Stretta system. The first two systems involve stitching the LES to create pleats that strengthen the muscle. The Stretta system utilizes electrodes to create small burns on the LES. Upon healing, the scar tissue helps toughen the muscle.

Complications

Chronic inflammation of the esophagus can lead to serious complications:

GERD may also worsen cases of asthma, chronic cough, and pulmonary fibrosis.

Philippine scenario

Gastroesophageal reflux disease among Filipinos has significantly been increasing over the last decade, a study done by the Endoscopy Unit of the University of Santo Tomas (UST) Hospital reports. Prevalence of GERD was significantly higher in 2000-2003 versus 1994-1997.

References