GERD (gastroesophageal reflux disease) is a prevalent condition in the present day. This disease has a reverse flow of stomach contents back into the oesophagus, causing the patient discomfort. Hydrochloric acid and digestive enzymes from the stomach return abnormally with swallowed food due to weakness or failure of the lower esophageal sphincter. Several factors contribute to the weakening of this sphincter. Discover key facts you should know about gastroesophageal reflux disease. Discover how to manage this condition.
Humans have a special muscle between their food pipe and stomach. This is a lower oesophageal sphincter which, thankfully, permits us to eat. When we swallow a bite of food, the sphincter relaxes, allowing it to pass readily into the belly (stomach). After you eat, stomach acids are activated to help with digestion. The sphincter tightens to stop the stomach acids from entering the oesophagus. In some people, however, this sphincter does not function as it should. Post-meal, the sphincter fails to tighten, leading to a regurgitation of stomach acid. There can be many reasons for this malfunction. Find out about the major ones.
GERD can exist concomitant to many diseases. One such disease is diabetes. Diabetes patients have been repeatedly shown to be affected by autonomic neuropathy. It may affect the tonic or strength of action of the sphincter muscle of the oesophagus. Gastric stasis can also be a complication of diabetes. Furthermore, some metabolic changes caused by diabetes can cause a high production of stomach acid. Combine all of this together, and it makes for an increased susceptibility to gastroesophageal reflux in people with diabetes.
Even some drugs may indirectly play a part in the development of GERD. This could be hormonal, as is the case with oral contraceptives, whose hormone elements tend to relax the lower oesophageal sphincter. Also, the hormone in contraceptive pills can play a role in fluid accumulation and swelling that can aggravate this disease. In addition, GERD can be influenced by medicines for the heart and high blood pressure. These drugs may relax the oesophageal muscles or slow stomach emptying.
Some foods and drinks, such as fatty and fried foods, chocolate, coffee, and carbonated drinks, may cause GERD. These types of foods and drinks can relax the lower oesophageal sphincter, making reflux of stomach contents into the oesophagus more likely. Alcohol also stimulates acid secretion and can harm the lining of the oesophagus, causing reflux symptoms to worsen. Plus, if you eat a heavy meal or eat right before sleep, your risk of heartburn and other GERD-related symptoms increases. Staying clear of specific foods and following a special diet can help work to eliminate the signs.
Smoking is a bad habit, which you probably know. It also aggravates GERD symptoms by inhibiting the function of the oesophageal sphincter. Nicotine is to blame. Moreover, smoke decreases saliva synthesis, neutralizing acidity, and protecting the oesophagus. Not to mention, smoking cigarettes with nicotine delays gastric emptying and increases the acidity of gastric juice. As a result, smoking cessation has a potentially important role in improving GERD symptoms.
Stomach acid production increases with stress, which, in turn, aggravates reflux symptoms. In addition, stress can decrease the tone of the lower oesophageal sphincter, making it easier for acid to flow back. So, it becomes essential to keep the stress levels under control in order to minimize the intensity of the symptoms.
Some anatomical defects, such as hiatal hernia or oesophageal deformity, can trigger the juice to move from the stomach to the oesophagus. In some cases, anatomical alterations may prevent the closure of the oesophagus after food has travelled through, resulting in repetitive irritation of the mucosa of the oesophagus.
Gastroesophageal reflux disease is a condition that typically presents with multiple undesirable digestive and upper respiratory symptoms. These symptoms can present differently and fluctuate in severity depending on specific triggers, making diagnosis challenging.
The most common and representative symptom is heartburn. It occurs when stomach contents come back and irritate the mucous membrane. Belching is also a common symptom of gastric reflux disease, which is the regurgitation of stomach contents into the mouth. This makes your breath smell bad and can lead to dental complications.
Although hiccups are actually a symptom of other conditions, people with GERD may get them due to irritation of the nerves of the oesophagus or stomach. Another symptom includes salivation, which occurs in response to irritation of the oesophagus or reflux-mediated reflexes. Chest pain may also occur, and it is a very alarming symptom for patients. It can be mistaken for a heart attack. Other symptoms are abdominal pain and nausea.
These symptoms are most commonly aggravated in the supine position because lying physiologically leads to increased reflux of stomach contents into the oesophagus. The same applies after a heavy, fatty meal, as fat retards gastric emptying and essentially allows reflux to occur.
Certain symptoms of GERD, like bleeding or pain while swallowing, are a sign that you need to see a doctor immediately! Bleeding can indicate a injury to the mucous membrane or ulcers. At the same time, swallowing difficulties can indicate changes in the oesophagus that need specialist treatment. Gastroesophageal reflux disease may also happen without clear signs or with a very subtle discomfort.
In a consultation, the patient describes the symptoms for the diagnosis of GERD and some other important things, such as whether there were other concomitant diseases and what medications the patient takes. Several medical tests assist in the diagnosis of GERD and the evaluation of its complications.
When a patient is suspected to have GERD, a variety of imaging tests are done. One excellent test is an upper GI tract endoscopy, known as gastroscopy. While not the most pleasant experience, this test permits a few pieces of the gastrointestinal covering for an investigation under a microscope. Also, the medical specialist can make an X-ray of the gastrointestinal tract. This test offers an in-depth image of the anatomy of the oesophagus and any damage.
The probe test is a medical examination that measures the acidity of the oesophagus. A thin probe is inserted into the oesophagus through the patient's nose to check for acid reflux and the lower oesophageal sphincter.
It is a type of functional test that helps evaluate the motility of the oesophagus and the pressure and function of the oesophageal muscles during swallowing. After swallowing, pressure changes are recorded from a thin, flexible probe with pressure sensors that is inserted into the esophagus. While imaging tests like tomography or resonance obtain visual images, oesophageal manometry does not provide pictures but rather a recording and data on the functionality of the oesophageal muscles.
Fortunately, when the disease is treated correctly and controlled, the prognosis for patients with GERD is good. With certain medications and lifestyle changes, most people are well into the normal range. However, if GERD is left untreated or is severe, complications may arise in some cases. So regular monitoring is needed. Following a doctor's instructions will help to prevent complications and improve the patient's prognosis.
First-line treatment of GERD is generally based on pharmacologic management. Certain pills affect stomach acid production. These are proton pump inhibitors, which are drugs that inhibit the stomach enzyme that makes acid, reducing acid production. Other medicines neutralize the acid in the abdomen and instantly alleviate symptoms. Through these mechanisms, medications help to alleviate heartburn, reflux, and irritation of the oesophagus. A doctor typically chooses the medications based on the specific situation of the patient.
Every doctor will also tell you to change some lifestyle habits to relieve the symptoms of GERD. One important point is dietary changes, which undoubtedly relieve symptoms and prevent complications.
Smaller, but more frequent meals are recommended. Fatty and spicy foods should be avoided during the diet as they irritate the oesophageal mucosa. Avoiding carbonated drinks and other products that can worsen the reflux is also advisable. Additionally, individuals with this problem should refrain from alcohol and cigarettes, because both substances aggravate the condition of the oesophageal mucosa and increase the risk of complications.
If patients are overweight or obese, losing excess weight is vital because it decreases pressure on the stomach and may relieve reflux complaints. Patients also need to sleep comfortably. Belts and any type of tight clothing may be not comfortable, as they can press on the abdomen and cause reflux. These life changes can make life with GERD easier, because they leave you with less frequent and less severe reflux symptoms.
Surgical management of GERD (gastroesophageal reflux disease) is for patients unresponsive to medical therapy or who have disease-related complications. Most surgical treatment of GERD are make laparoscopically, which minimizes recovery time and complication risk.
While GERD is usually a mild disease, if untreated and not under control, it can cause many complications. Patients, for example, can develop Barrett's oesophagus. In this pathological condition, the normal epithelium of the mucous membrane of the oesophagus is replaced with an epithelium type resembling that of the stomach.
Inflammation can also be caused by reflux. It happens when the stomach acid irritates the lining of the oesophagus, and a recurrent course of this action makes the oesophagus inflamed, which causes oesophageal ulcers and bleeding. GERD can also cause acid from the stomach to pass into the oesophagus and irritate respiratory organs, including the larynx and sinuses, causing inflammation in these areas, too.
And in certain GERD sufferers, this constant irritation of the lining of the oesophagus additionally results in scarring and a narrowing of the oesophagus. In addition, acid erodes the enamel, which is why acid reflux often gets patients in trouble with dental problems. The final and most severe complication of GERD is oesophageal cancer. People who have Barrett's oesophagus are also at a higher risk of this type of malignancy.
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