Gastroesophageal reflux disease

Contents 1 What is it? 2 Symptoms 3 Cause of Ailment 4 Who gets it? 5 How is it diagnosed? 6 How is it treated? 7 What is the long-term prognosis? 8 Related Articles 9 More information

What is it?

Gastroesophageal reflux disease (GERD) is a condition where the acidic gastric juices travel up from the stomach and back into the esophagus. In the process of digestion, the strong acids in the stomach partially digest the food to break it down into simpler forms so that the body can use the energy and further digest it (in the intestines). In healthy digestion, this partially digested acidic content is pushed down into the small intestine by a muscle, called the pyloric sphincter, in the stomach. However, in those who suffer GERD, the stomach acid content refluxes back up into the esophagus, eventually causing inflammation and sometimes, damage.

Symptoms

The symptoms of GERD can vary a bit from person to person. Here is a list of some of the common symptoms:

• Heartburn, also known as acid reflux
• Burning sensation moving from stomach up towards throat
• Regurgitation of food, especially shortly after eating
• Chest pain
• Upper belly or lower chest discomfort that gets worse after during or after eating or while sleeping.
• Difficulty swallowing food or even in extreme cases, liquid.
• In nearly half of those cases of people who suffer GERD, they also suffer esophagitis- this can lead to damage of the esophagus.

Cause of Ailment

Technically, GERD is caused by a problem with the lower esophageal muscles, called the sphincter. This tight ring of muscles that acts as a value between the esophagus and stomach does not work when it should; it closes and opens when it should not.

In some people it is possible that the contents of the stomach do empty quickly enough as as it result it becomes over-stuffed or backlogged with digestive contents. However, it is hard to say if this is the cause or the result of GERD.

There are other lifestyle factors that may contribute to this reaction happening in the body:

• Obesity or even minimal weight gain can contribute to getting GERD.

• Stress

• Certain foods and beverages can certainly make GERD worse. Which foods make your GERD worse may not make someone else's worse. Some of the most universally offending foods are:
  • Caffeine
  • Alcohol
  • Sugars
  • Citris fruits
  • Fatty foods
  • Dairy (for some)
  • Spicy foods

Who gets it?

Anyone can get GERD, although adults over the age of 40 seem most prone to it. It is estimated that 40% if the adults western population suffer from heartburn. Heartburn is a leading symptom of GERD, but not everyone with heartburn has GERD. Some statistics suggest that men are more likely than women to suffer from GERD.

How is it diagnosed?

Other than the evaluation of symptoms the only real way to diagnose GERD is through a endoscopy. This is a procedure where they feed a tube, with a mini camera on it, down the throat. Through this camera, they can evaluate the condition of the stomach and esophageal lining. They can also take a biopsy of the lining to test for cancerous cells.

How is it treated?

Medication

The most popular form of treatment is over the counter or prescription drugs:

• Antacids- pills or liquids that are used to treat acid-related symptoms, such as heartburn or indigestion. They can help to neutralize acid in the stomach through aluminum compounds, a calcium carbonate compound and or a magnesium compound. Most are sold over-the-counter. However, they are not recommended for those who suffer from chronic reflux conditions.

• H-2 Blockers- these drugs (also mostly sold over the counter) decrease the amount of acid produced by the stomach.
  

• Proton pump inhibitors- These are stronger than H-2 blockers in decreasing acid production in the stomach.
  

• Coating drugs, such as Sucralfate- Can be used to protect an irritated or inflammed esophagus.
  

• Promotility drugs- this drug helps tone the muscles at the base of the esophagus so that they may do a better job of emptying food from the stomach.
  

Dietary and Lifestyle changes

• Many people find that making changes to their diet, by cutting out many of the foods listed above, can help to reduce symptoms associated with GERD.
• Do not lie down right after eating meals; it is best to wait 2-3 hours after eating before going to bed. It is also helpful to elevate the top of your bed a few inches so that your head is above your stomach- thus minimizing reflux as it comes up.
• It also helps to eat small, frequent meals rather than big, less regular ones.
• Some also find that losing weight- people with excess weight have a higher incidence of GERD.
• Eliminating sources of stress (such as exhaustive work schedules) can bring the body into greater balance.
• Stop smoking. Smoking can increase reflux.
• Avoid wearing tight fitting waistbands or bras.

Natural remedies

• Many find a huge improvement in their heartburn and GERD symptoms by taking probiotics or acidophilus supplements. These help to return the digestive flora to its optimal PH level. These supplements, found in most health food stores, should be taken daily on an empty stomach.
• Aloe vera gel has also been known to help the negative symptoms of GERD. Aloe vera gel coats the digestive tract and helps it to heal from ulcerous and acidic conditions.
• DGL tablets- deglycyrrhizinated licorice. This is a wafer that is sucked on; it can be found at natural health food stores.

Surgery

The minimally invasive procedure that is done for GERD is called fundoplication. In this surgery the lower part of the esophageal sphincter is wrapped with the upper part of the stomach to tighten that muscle. This can be done laproscopically, so there is minimal invasiveness. There is much risk associated with this mode of treatment and should be considered a last resort option; however, those that have undergone have reported an effectiveness in reducing the symptoms of GERD.

What is the long-term prognosis?

• If GERD is treated successfully, symptoms can go away permanently - or they may return at a later date and need an additional course of treatment.
• A flare up of GERD can last days, weeks or months. Generally, treatment is essential for chronic cases.
• Inflammation from GERD that is left untreated can cause damage where the lining of the esophagus becomes ulcerated from the continual acidic reflux. This ulceration can lead to scarring then narrowing which makes swallowing difficult and painful.
• In extreme cases, where treatment is not sought, there is an increased risk of esophageal cancer, known as Barrett's syndrome.
• Ulcers can also be a side effect of long term, untreated GERD. This can be very dangerous as it can lead to bleeding and/or perforation of the stomach wall.

Related Articles

• Antacids

More information

• American College of Gastroenterology P.O. Box 342260 Bethesda, MD 20827-2260 (301) 263-9000