Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease, Peptic esophagitis; Reflux esophagitis; or Heartburn - chronic, occurs when the food or liquid ingested travels backwards from the stomach to the esophagus (the tube that carries food from the mouth to the stomach). The reason being that the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus.
Heartburns are a common occurrence but that does not necessarily mean one has GERD. If ignored, GERD can finally lead to serious health conditions. Infants, children, and pregnant women are easily susceptible to GERD.
CAUSES
It is difficult to narrow down actual causative factors for GERD. In case heartburn occurs more than twice a week it may be considered GERD.
The following are the risk factors:
Hiatal hernia: It is a condition when the upper part of the stomach is above the diaphragm. Diaphragm is the muscle wall that separates the stomach from the chest. The diaphragm assists the function of LES. It keeps acid from coming up into the esophagus. In case of a hiatal hernia condition it is easier for the acid to reflux.
Pregnancy
Scleroderma
Some lifestyle factors too can be promotive of GERD ,like
alcohol use
overweight
pregnancy
smoking
Excessive consumption of certain food items like citrus fruits, chocolate, drinks with caffeine, fatty and fried foods, spicy food, too can encourage GERD.
SYMPTONS
The main symptoms are:
Persistent heartburn due to acid regurgitation.
Pain in the chest, GERD can also result in dry cough and bad breath.
Nausea and vomiting
Cough or wheezing
Belching.
Vomitting blood
Scars from tissue damage can narrow the esophagus and make swallowing difficult, also giving a feeling of tightness in the throat.
Hoarseness in the morning. Change in voice.
Studies indicate that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.
Chronic cases can develop into Barrett's esophagus, where cells in the esophageal lining take on an abnormal shape and color, which over time can lead to cancer.
GERD and Children
Immature digestive system is the main reason, why children are susceptible to GERD. Most infants grow out of GERD by the time they are 1 year old. Taking simple measures like, burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after the feed can render relief. In case of an older child, regulating intake of food articles that stimulate GERD, like sodas, acidic and spicy, fried and fatty food is recommended. Sleeping position where in the head of the child is raised also works.
PREVENTION
In case of GERD, prevention involves mainly life style alterations:
Quit/ Reduce
Maintain a healthy weight.
Avoid alcohol consumption.
Eat small meals.
Do not lie down for at least 3 hrs after meals.
Take medication with lot of water.
Sleep with head raised.
Wear loose clothes.
TREATMENT
(1) Medications: Over the counter medication may be recommend, like antacids that may be bought without a prescription. Even medications that stop acid production can give relief.
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. These antacids are usually different combinations of three basic salts%u2014magnesium, calcium, and aluminum%u2014with hydroxide or bicarbonate ions to neutralize the acid in your stomach.
Antacids have side effects:
(1) Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation.
(2) Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also cause constipation.
Foaming agents, assist by covering the stomach contents with foam to prevent reflux. These drugs may be of use to those who have no damage to the esophagus.
Drugs that impede acid production, H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75. They are over the counter drugs and also available in prescription strength. These drugs do provide relief but are not to be consumed on a long-term basis.
Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost all GERD people.
Prokinetics help strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract.
As every individual drug has varied effect, a combination of drugs is most effective. That is for people who get heartburn after eating may consume both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production.
In case of persistent GRED, further tests can be taken:
A barium swallow radiograph: It uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. With this test, you drink a solution and then x rays are taken. Mild irritation will not appear on this test, although narrowing of the esophagus-called stricture-ulcers, hiatal hernia, and other problems will.
Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor's office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.
The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found.
In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus. This test is useful in people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.
SURGERY
Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.
Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.
This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.
In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.
IMPLANT
Recently the FDA approved an implant that may help people with GERD who wish to avoid surgery. Enteryx is a solution that becomes spongy and reinforces the LES to keep stomach acid from flowing into the esophagus. It is injected during endoscopy. The implant is approved for people who have GERD and who require and respond to proton pump inhibitors. The long-term effects of the implant are unknown.
Much research is needed into the role of the bacterium Helicobacter pylori. Our ability to eliminate H. pylori has been responsible for reduced rates of peptic ulcer disease and some gastric cancers. At the same time, GERD, Barrett's esophagus, and cancers of the esophagus have increased. Researchers wonder whether having H. pylori helps prevent GERD and other diseases. Future treatment will be greatly affected by the results of this research
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