Gastroesophageal reflux disease is a chronic disease that involves the digestive system.
GERD occurs when stomach acid or stomach contents return to the esophagus.
Ingesting large amounts of food or leaning forward after eating food can sometimes cause heartburn and a reflux that causes a bitter taste in the mouth.
Reflux or backwash irritates the lining of the esophagus and causes GERD.
Acid reflux and heartburn are very common digestive conditions that many people experience occasionally.
When signs and symptoms occur at least twice a week or interfere with daily activities or when there is damage to the esophagus or ulcers are caused, you may be diagnosed with GERD.
Most cases of GERD can be treated with simple changes in lifestyle and the use of over-the-counter medications.
However, some cases require stronger medications or even surgery to relieve symptoms.
Normally, when food is swallowed, it first travels through the esophagus. A valve is opened to allow food to pass into the stomach and then the valve closes.
With GERD, the valve does not close properly. Stomach acid and stomach juices flow upward (reflux) into the esophagus.
GERD is caused directly by frequent acid reflux or the accumulation of stomach acid or bile in the esophagus. Abnormalities or weakening of the lower esophageal sphincter cause this.
Constant backwash of the acid can cause an irritation of the esophageal lining that leads to inflammation ( esophagitis ).
Eventually, the inflammation can damage the lining of the esophagus, which can cause complications such as bleeding, narrowing of the esophagus or Barrett’s esophaguswhich is a precancerous condition.
The conditions that increase the risk of GERD are:
- Obesity .
- Hernia hiatal.
- The pregnancy.
- Asthma .
- Delayed stomach emptying
- Connective tissue disorders such as scleroderma .
The first symptom of GERD is the presence of heartburn. There is burning or heat right in the area behind the sternum, and even pain.
These types of symptoms commonly appear at night when you are lying flat on the bed.
The burning sensation that is caused by GERD usually occurs after meals.
Heart pain usually feels like an oppression, or a dull pain. Generally the symptoms of GERD are:
- Burning stomach or burning sensation in the chest that can spread to the throat and leave a bitter taste in the mouth.
- Lesser chest pain
- Dysphagia or difficulty swallowing
- Dry cough.
- Sore throat or hoarseness
- Acid reflux or regurgitation of sour liquid or food.
- The feeling of having a lump in the throat.
You should seek immediate medical attention if you experience chest pain, especially if you have other signs and symptoms of shortness of breath or pain in your jaw or arm.
Since these symptoms can mask the symptoms of a heart attack .
Most people with GERD do not have other serious problems other than symptoms, but prolonged reflux can cause:
- Esophagitis: inflammation of the lower esophagus
- Stenosis : long-lasting severe inflammation can cause narrowing of the esophageal lumen
- Barrett’s esophagus: changes in the cells of the lower esophagus, due to damage caused by long-lasting acid reflux. Patients with Barrett’s esophagus have an increased risk of esophageal cancer compared to the general population.
If you experience GERD symptoms frequently or take over-the-counter heartburn medications two or more times in a week, it might be best to see your healthcare provider.
First, a physical examination and the corresponding medical history will be done. It may or may not need more evidence. The doctor can diagnose GERD based on experiencing symptoms such as heartburn.
The diagnosis of GERD depends on several factors:
Upper GI series (barium swallow): This outpatient procedure uses X-ray images to examine the upper gastrointestinal tract for ulcers, reflux, and physical abnormalities, such as a hiatal hernia. To aid visualization, the patient ingests a thick, calcareous liquid contrast agent containing barium.
Upper endoscopy: endoscopy is a more invasive but accurate test to detect lesions and complications related to GERD, such as ulcers, tumors and inflammation.
Once the throat is numb, a small camera attached to a thin, flexible tube feeds through the esophagus to look for injured tissue and collect samples if necessary.
Esophageal monitoring: A test is used to control the amount of acid in the esophagus. PH monitoring and manometry evaluate the environment and function of the esophagus.
PH monitoring (often in conjunction with upper endoscopy) measures acid levels and the degree of reflux in the lower esophagus, while manometry measures the strength of muscle contractions, including that of the LES.
For milder symptoms of heartburn, over-the-counter medications can be given.
Initial treatments for heartburn are usually:
- Antacids to neutralize stomach acid.
- Medications to reduce the production of acid.
- Drugs that block the production of acid and heal the esophagus.
- These include antacids such as Tums, H2 blockers such as famotidine (Pepcid), and proton pump inhibitors such as omeprazole (Prilosec).
In case the acidity does not disappear within a few weeks, once the treatment is started, then the specialist is likely to diagnose GERD.
Treatments of heartburn with signs and symptoms of GERD, which are generally used prescription drugs, which are:
- Blockers of the H-2 receptor of prescribed concentration.
- Inhibitors of the proton pump of prescribed intensity.
- Medications that strengthen the lower esophageal sphincter.
When medications do not work or if they can not take medication due to side effects, the doctor may recommend surgery.
Nissen fundoplication surgery strengthens the valve between the esophagus and stomach, wraps the upper part of the stomach around the end of the esophagus with sutures that create pressure at the end of the esophagus.
What prevents gastric acid and food from being returned from the stomach to the esophagus, causing GERD.
The endoluminal fundoplication procedure is currently being used.
But many patients may continue to need medication even after surgery.
GERD is a very common condition in pregnant women.
Changes in lifestyle and antacids are usually first tested to treat pregnant women with GERD.
Over-the-counter antacids are mostly safe and can be used during pregnancy to treat symptoms.
Antacids that contain sodium bicarbonate can cause fluid to accumulate, so they should not be administered to pregnant women.
The use of antacids containing magnesium trisilicate is not recommended, as these may not be safe for the baby’s development.
The use of antacids based on calcium carbonate is recommended.
If the changes made in the patient’s lifestyle do not control the symptoms, the patient must go to the doctor to obtain the necessary information for the use of other medicines that are safe for the baby.
But, usually the symptoms disappear or improve after the birth of the baby.
In the management of GERD, it is likely that medications should be prescribed for many years in order to control the symptoms.
But it is also necessary to make some changes in the lifestyle of the patient to help alleviate the common symptoms of GERD.
These changes in lifestyle can help reduce the severity and frequency of heartburn:
- Maintain a healthy weight since excess weight exerts more pressure on the abdomen.
- Avoid foods and beverages that can trigger heartburn, including fatty foods, fried foods, tomato sauce, alcohol, mint, chocolate, onions, caffeine and carbonated beverages.
- Eat meals in smaller amounts.
- Do not lie down after a meal. Wait at least three hours before bedtime.
- No Smoking.
- Raise the head of your bed.
- Exercise regularly