HEALTH TALK: Gastroesophageal reflux disease

DEFINITION

Gastroesophageal reflux disease (GERD) is a chronic digestive disease that happens when stomach acid or, sometimes, bile, flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus and causes GERD signs and symptoms.

Signs and symptoms of GERD include acid reflux and heartburn. Both are common digestive conditions that most people experience from time to time. When these signs and symptoms occur more than twice a week or interfere with your daily life, we call this GERD.

Most can manage the discomfort of heartburn with lifestyle changes and over-the-counter medications. But for people with GERD, these remedies may offer only temporary relief. People with GERD may need stronger medications, even surgery, to reduce symptoms.

SYMPTOMS

GERD signs and symptoms include:
•    A burning sensation in your chest (heartburn), sometimes spreading to the throat, along with a sour taste in your mouth.
•    Chest pain
•    Difficulty swallowing
•    Dry cough
•    Hoarseness or sore throat
•    Regurgitation of food or sour liquid (acid reflux)
•    Sensation of a lump in the throat

WHEN TO SEE A DOCTOR

See doc immediately if you experience chest pain, especially when accompanied by other signs and symptoms such as shortness of breath or jaw or arm pain. These may be signs and symptoms of a heart attack.

If you experience severe or frequent GERD symptoms, or use over-the-counter medications for heartburn more than twice a week, time to see doc.

CAUSES

GERD is caused by frequent acid reflux – the backup of stomach acid or bile into the esophagus.

When you swallow, the lower esophageal sphincter – or circular band of muscle around the bottom part of your esophagus (you may think of it as a valve) – relaxes to allow food and liquid to flow down into your stomach. Then it closes again.

However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn. This constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems.

RISK FACTORS

These conditions can increase your risk of GERD:
•    Obesity
•    Hiatal hernia
•    Pregnancy
•    Smoking
•    Dry mouth
•    Asthma
•    Diabetes
•    Delayed stomach emptying
•    Zollinger-Ellison syndrome
•    Connective tissue disorders, such as scleroderma

COMPLICATIONS

Over time chronic inflammation in your esophagus can lead to complications, including:

•    Narrowing of the esophagus (esophageal stricture). Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue which can narrow the food pathway, causing difficulty swallowing.

•    An open sore in the esophagus (esophageal ulcer). Stomach acid can severely erode tissues in the esophagus, causing an open sore to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.

•    Precancerous changes to the esophagus (Barrett’s esophagus). In this condition, the color and composition of the tissue lining the lower esophagus change. These changes are associated with an increased risk of esophageal cancer. The risk of cancer is low, but doc will recommend regular endoscopy exams to look for early warning signs of esophageal cancer.

TESTS AND DIAGNOSIS

Diagnosis may be made on the basis of frequent heartburn or other signs and symptoms. But doc may also suggest tests and procedures to diagnose GERD, including:

•    An X-Ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, the procedure involves drinking a chalky liquid that coats and fills the hollows of your digestive tract. Then X-Rays are taken of your upper digestive tract. The coating allows doctor to see a silhouette of the shape and condition of your esophagus, stomach and upper intestine (duodenum).

•    Endoscopy. A flexible tube is passed down your throat, allowing doc to examine the esophagus and stomach, and even collect a sample of tissue (biopsy) for further testing. Of course the tube has a light and camera.

•    A test to monitor the amount of acid in your esophagus. An acid-measuring device can identify when and for how long, stomach acid regurgitates into your esophagus. Doc may ask that you stop taking GERD medications to prepare for this test.

•    A test to measure the movement of the esophagus. Esophageal impedance measures movement and pressure in the esophagus. The test involves placing a catheter through your nose and into your esophagus.

TREATMENT AND DRUGS

You may start with over-the-counter drugs. If there’s no relief in a few weeks, doc may recommend other treatments, including medications and surgery.

Initial treatments to control heartburn

•    Antacids that neutralize stomach acid. You know many of these, but you should know that by themselves they won’t heal an inflamed esophagus.

•    Medications to reduce acid production. These are called H-2 receptor blockers. Stronger versions of these medications are available in prescription form.

•    Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal.

Contact your doctor if these medications don’t seem to be helping after a few weeks. Prescription strength of these medications will then be given, in addition to those called prokinetic agents, which help your stomach empty more rapidly and help tighten the valve between your stomach and esophagus.

Of course, there is surgery when medications don’t help. There are procedures such as:

•    Surgery to reinforce the lower esophageal sphincter. Called Nissen, (not Nissan) fundoplication, this surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus. This may be open surgery or by laparoscopy.

•    Surgery to create a barrier preventing the backup of stomach acid. This is called the EndoCinch endoluminal gastroplication. It uses pairs of stitches in the stomach near the weakened sphincter. The stitches are then tied together, creating barriers to prevent stomach acid from washing into your esophagus.

•    A procedure to form scar tissue in the esophagus. This is the Stretta system, using electrode energy to heat esophageal tissue. The heat creates scar tissue and damages the nerves that respond to refluxed acid. Scar tissue that forms as the esophagus heals, help to strengthen the muscles.

WHAT YOU CAN DO

•    Maintain a healthy weight.
•    Avoid tight-fitting clothes.
•    Don’t lie down after a meal.
•    Don’t exercise too soon after a meal.
•    Allow three to four hours after your last meal before you go to bed.
•    Don’t eat large meals.
•    Avoid foods that trigger heartburn. These include fatty or fried foods, alcohol, chocolate, mint, garlic, onion, tomato, or tomato products, citrus fruits and drinks, spicy foods, caffeine (coffee), tea (tea bags), colas (soft drinks).
•    Minimize smoking, or don’t do it at all.
•    Elevate the head of your bed by at least six inches.

See you next week.

Copyright 2012 Dominica News Online, DURAVISION INC. All Rights Reserved. This material may not be published, broadcast, rewritten or distributed.

Disclaimer: The comments posted do not necessarily reflect the views of DominicaNewsOnline.com and its parent company or any individual staff member. All comments are posted subject to approval by DominicaNewsOnline.com. We never censor based on political or ideological points of view, but we do try to maintain a sensible balance between free speech and responsible moderating.

We will delete comments that:

  • contain any material which violates or infringes the rights of any person, are defamatory or harassing or are purely ad hominem attacks
  • a reasonable person would consider abusive or profane
  • contain material which violates or encourages others to violate any applicable law
  • promote prejudice or prejudicial hatred of any kind
  • refer to people arrested or charged with a crime as though they had been found guilty
  • contain links to "chain letters", pornographic or obscene movies or graphic images
  • are off-topic and/or excessively long

See our full comment/user policy/agreement.

5 Comments

  1. Judy
    April 25, 2011

    You diagnosed me correctly. The one thing I will definitely do is put a wedge under my mattress. Is a twisted esophogus anything to be concerned about?

  2. me R
    April 20, 2011

    While i am reading this info am suffering from the symptoms, when this happens i take DICA or a glass of milk, it helps a lot. Thank you so very much Doctor for showing me the serious side of this reflux.

  3. Family Guy!
    April 20, 2011

    Thanks doc! very useful information, because i normally eat and just go to bed..i must stop that!

  4. good
    April 20, 2011

    Great info doctor.. I suffered with GERD a few years ago, and i must say it’s not a good feeling at all..Taking the rite herbal medication and changing my eating habits have made me feel so much better..AS a matter of fact i don’t suffer from this disease anymore..Thank God!!!

  5. Michael
    April 20, 2011

    Thanks, Doc. I suffer from the GERD and, of course, I am interested in learning how it can be treated. The info is useful.

Post a Comment

Your email address will not be published. Required fields are marked *

:) :-D :wink: :( 8-O :lol: :-| :cry: 8) :-? :-P :-x :?: :oops: :twisted: :mrgreen: more »

 characters available