Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) – know It All!

Editorial

All you need to know about Acid Reflux (GERD).

Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD)

Know your ailment well, so you can manage it better!!

Here we come with Acid Reflux today!

Overview:

Acid Reflux is also referred to as Gastroesophageal reflux disease (GERD).

Gastroesophageal reflux disease ( GERD) occurs when acid from the stomach often flows back into the tube that connects your mouth and stomach (esophagus). This backwash (acid reflux) can irritate your esophageal lining.

Occasionally many people experience acid reflux. GERD is a mild acid reflux occurring at least twice a week, or a moderate to severe reflux of acid occurring at least once a week.

Many people can control GERD’s pain by improvements in lifestyle and over-the-counter medicines. But some people with GERD may need to take stronger drugs or surgery to ease symptoms.

Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD)

How does it occur?

Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD)

Acid reflux occurs when your esophagus at the lower end of the sphincter muscle relaxes at the wrong time , allowing stomach acid back into your esophagus. That can cause heartburn, as well as other signs and symptoms. Frequent or constant reflux may result in GERD (Gastroesophageal Reflux Disease).

Who Develops GERD ?

The following conditions contribute to GERD as risk factors:

  • Obesity
  • Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
  • Pregnancy
  • Connective tissue disorders, such as scleroderma
  • Delayed stomach emptying

The following factors can aggravate the existing acid reflux:

  • Smoking
  • Eating large meals or eating late at night
  • Eating certain foods (triggers) such as fatty or fried foods
  • Drinking certain beverages, such as alcohol or coffee
  • Taking certain medications, such as aspirin

Causes:

Frequent acid reflux triggers GERD.

A circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes as you swallow, allowing food and liquid to flow through your stomach. The sphincter then closes again.

The stomach acid will flow back into your esophagus if the sphincter relaxes abnormally or weakens. The persistent acid backwash irritates the esophagus lining and also causes it to become inflamed.

Common symptoms of GERD are as follows:

  • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
  • Chest pain
  • Difficulty swallowing
  • Regurgitation of food or sour liquid
  • A sensation of a lump in your throat

If you have nighttime acid reflux, you might also experience:

  • Chronic cough
  • Laryngitis
  • New or worsening asthma
  • Disrupted sleep

How is it Diagnosed ?

The doctor can be able to diagnose GERD based on the signs and symptoms including a physical examination and history.

Your doctor can recommend:the following tests to confirm a GERD diagnosis or to test for complications.

Upper endoscopy: To explore the inside of your esophagus and stomach, the doctor inserts a small , flexible tube fitted with a light and camera (endoscope) down your throat. When reflux is present, test results may sometimes be normal, but an endoscopy can detect inflammation of the esophagus (esophagitis) or other complications. The endoscopy can also be used to collect a tissue sample (biopsy) that will be checked for conditions like Barrett’s esophagus.

Ambulatory acid (pH) test: A sensor is put in your esophagus to assess when and for how long your stomach acid can regurgitate. The device attaches to a small device that you wear with a harness over your shoulder or around your waist. The display may be a small , flexible tube (catheter) that gets threaded into your esophagus through your nose, or a clip that is inserted in your esophagus during an endoscopy and transferred through your stool for about two days.

Esophageal manometry: This test tests the contractions of the rhythmical muscle in the esophagus while swallowing. Esophageal manometry often tests the coordination and energy exerted by the esophageal muscles.

X Ray — Radiography of the upper digestive system: X-rays are taken after you drink a chalky liquid that covers and fills the digestive tract’s inner lining. The coating helps the doctor to see an outline of the upper intestine, stomach and esophagus. You may also be required to swallow a barium pill which may help treat an esophagus narrowing and can interfere with swallowing.

Treatment Options:

Over-the-counter medications:

The options include:

  • Antacids that neutralize stomach acid. Antacids may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems.
  • Medications to reduce acid production. These medications — known as H-2-receptor blockers — include cimetidine, famotidine and nizatidine. H-2-receptor blockers don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription.
  • Medications that block acid production and heal the esophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole and omeprazole.

Sometimes prescription medicine with varying strengths is also considered.

Surgery and other procedures

GERD can usually be controlled with medication. But if medications don’t help or you wish to avoid long-term medication use, your doctor might recommend:

  • Fundoplication. The surgeon wraps the top of your stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete.
  • LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The LINX device can be implanted using minimally invasive surgery.
  • Transoral incisionless fundoplication (TIF). This new procedure involves tightening the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners. TIF is performed through the mouth with a device called an endoscope and requires no surgical incision. Its advantages include quick recovery time and high tolerance.
    If you have a large hiatal hernia, TIF alone is not an option. However, it may be possible if TIF is combined with laparoscopic hiatal hernia repair

How to Cope up:

Lifestyle changes may help reduce the frequency of acid reflux. You Should:

  • Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to reflux into your esophagus.
  • Stop smoking. Smoking decreases the lower esophageal sphincter’s ability to function properly.
  • Elevate the head of your bed. If you regularly experience heartburn while trying to sleep, place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches. If you can’t elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows isn’t effective.
  • Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
  • Eat food slowly and chew thoroughly. Put down your fork after every bite and pick it up again once you have chewed and swallowed that bite.
  • Avoid foods and drinks that trigger reflux. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
  • Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.

References:

https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

Hershcovici T, Fass R (April 2011). “Pharmacological management of GERD: where does it stand now?”. Trends in Pharmacological Sciences. 32 (4): 258–64. doi:10.1016/j.tips.2011.02.007. PMID 21429600.

https://doi.org/10.1053/j.gastro.2008.08.045

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.