Gastroesophageal Reflux Disease

Gastroesophageal reflux disease, commonly referred to as GERD, or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up, or refluxes) into the esophagus. GERD can usually be diagnosed based on the clinical presentation alone. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach . Most people experience acid reflux from time to time as heartburn, a burning sensation below the breast bone that occurs after eating or at night. Heartburn is so common that it often is not associated with a serious disease, like GERD. The gastroesophageal junction must be located in the abdomen so that the diaphragmatic crura can assist the action of the LES, thus functioning as an extrinsic sphincter. Acid is believed to be the most injurious component of the refluxed liquid. This occurs when the valve of smooth muscle between the esophagus and the stomach does not function properly. The symptoms of gastroesophageal reflux disease (GERD) vary from patient to patient, and multiple diagnostic tests and treatments are available Various methods to effectively treat GERD range from lifestyle measures to the use of medication or surgical procedures. Therefore, reflux that occurs at night is more likely to result in acid remaining in the esophagus longer and causing greater damage to the esophagus. This can be due to incompetence of the lower esophageal sphincter (LES), transient LES relaxation, impaired expulsion of gastric reflux from the esophagus, or association with a hiatal hernia .

The typical symptom is heartburn. This most often occurs 30–60 minutes after meals and upon reclining. Patients often report relief from taking antacids or baking soda. When this symptom is dominant, the diagnosis is established with a high degree of reliability. Many patients, however, have less specific dyspeptic symptoms with or without heartburn. Overall, a clinical diagnosis of gastroesophageal reflux has a sensitivity of 80% but a specificity of only 70%. Severity is not correlated with the degree of tissue damage. In fact, some patients with severe esophagitis are only mildly symptomatic. Patients may complain of regurgitation—the spontaneous reflux of sour or bitter gastric contents into the mouth. Less common symptoms include dysphagia, which may be due to abnormal peristalsis or the development of complications such as stricture or Barrett's metaplasia.

"Atypical" manifestations of gastroesophageal disease are being recognized with increasing frequency. These include asthma, chronic cough, chronic laryngitis, sore throat, and noncardiac chest pain. Gastroesophageal reflux may be either a causative or an exacerbating factor in up to 50% of these patients, especially those with refractory symptoms. Because many of these patients do not have heartburn or regurgitation, the diagnosis often is overlooked.

Gallstones affect as many as one in 12 Americans. Gastroesophageal reflux disease (GERD) occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit, causing symptoms with or without associated esophageal mucosal injury (ie, esophagitis).Acid is believed to be the most injurious component of the refluxed liquid In some patients, however, the diagnosis may require endoscopy and, rarely, ambulatory pH monitoring. Management includes lifestyle modifications and pharmacologic therapy; refractory disease requires surgery.Gastroesophageal reflux disease (GERD) is a condition in which food or liquid travels from the stomach back up into the esophagus (the tube from the mouth to the stomach). The links are to resources on GERD in infants, GERD in children and adolescents, GERD diets infomation, GERD recipes, meds and other remedies for treating GERD, complications of GERD, and surgical procedures for treating GERD. Moreover, after the esophagus has healed with treatment and treatment is stopped, the injury will return in most patients within a few months.Fortunately, treatment is usually straightforward, and newer techniques often allow faster recovery time.It is essential for individuals who suffer persistent heartburn or other chronic and recurrent symptoms of GERD to seek an accurate diagnosis, to work with their physician, and to receive the most effective treatment available.

Causes of Gastroesophageal Reflux Disease

The common causes of Gastroesophageal Reflux Disease :-

• These small, dark brown or black stones form when your bile contains too much bilirubin. It's not always clear what causes them.
• These gallstones, often yellow in color, are composed mainly of undissolved cholesterol, although they can also have other components, such as calcium and bilirubin, the residue from the breakdown of red blood cells.
• tomato-based foods, like spaghetti sauce, chili, and pizza
• Stomach acid flows into the esophagus (called acid reflux), causing the burning sensation.
• Use of alcohol or cigarettes, obesity , poor posture (slouching)
• Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acid foods such as citrus fruits and tomatoes, spicy foods, mint flavorings

Symptoms of Gastroesophageal Reflux Disease

Some are common symptoms of Gastroesophageal Reflux Disease :-

• Heartburn is usually worse after eating.
• Regurgitation of bitter acid up into the throat while sleeping or bending over
• burning chest pain, also known as heartburn - can last up to two hours and is often made worse by eating, lying down or bending over.
• Feeling of tightness in the throat, as if a piece of food is stuck
• Involves a burning pain in the chest (under the breastbone)
• sour or bitter taste in the throat or back of the mouth
• Symptoms of gastroesophageal reflux include vomiting, heart burn, narrowing of the esophagus, recurrent pneumonia, breathing problems and slow growth.

Treatment of Gastroesophageal Reflux Disease

The goal of treatment is to provide symptomatic relief, to heal esophagitis (if present), and to prevent complications. In the majority of patients with uncomplicated disease, empirical treatment is initiated based upon a compatible history without the need for further confirmatory studies. Patients not responding and those with suspected complications undergo further evaluation with upper endoscopy or esophageal pH recording.

• Goals of treatment are reducing reflux, relieving symptoms, and preventing damage to the esophagus
• Avoiding dietary fat, chocolate, caffeine, peppermint (they may cause lower esophageal pressure)
• As soon as your child feels well enough, he or she will be allowed to eat, drink and take pain medication orally (usually one to two days after surgery).
• Avoiding alcohol and tobacco
• After fundoplication, food and fluids can pass into the stomach but are prevented from backing up into the esophagus.
• Antacids were the standard treatment in the 1970s and are still effective in controlling mild symptoms of GERD
• Patients with symptoms that are not completely controlled by proton pump inhibitor therapy can be considered for surgery.

Patients with known erosive esophagitis, complications (such as a peptic stricture or Barrett's esophagus), or suspected atypical manifestations (such as asthma or laryngitis) are treated initially with a proton pump inhibitor (see below). In most other patients, treatment may proceed in the following stepwise fashion.

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