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Gastroesophageal Reflux Disease (GERD)

GERD is a recurrent condition where gastric juices, containing acid, travel back from the stomach into the gullet (the swallowing pipe called the esophagus).

The food in the stomach is partially digested by stomach acid and enzymes (special chemicals that act on food to break it down to simpler material that the body can use). Normally, the partially digested acidic content in the stomach is delivered by the stomach muscle into the small intestine for further digestion. In patients with GERD, stomach acid content regularly refluxes backwards into the esophagus, causing inflammation and damage.

How do you get GERD?
Doctors know that in western countries, 40% of adults suffer from heartburn, the main symptom of GERD. About 50 % of patients with GERD also have esophagitis or inflammation of the esophagus.

In most people, GERD is caused by the digestive juices in the stomach, repeatedly moving upwards into the lower esophagus (called acid reflux). The condition may be due to an abnormal mechanical working of the esophagus (where it enters the stomach) since it can normally squeeze itself together to act as a shut-off valve, or tap, to keep stomach contents out.

It can occur in some people when the stomach does not empty quickly enough and becomes overfilled with digestion contents. GERD can also occur in people with a condition called a hiatal hernia (see below).

How serious is GERD?
In some patients, the damage to the esophagus can be seen during an endoscopic examination. This involves a doctor feeding a tube with a special camera down the patient's throat into the esophagus. However, even when damage cannot be seen, patients can experience severe symptoms.

Heartburn is the most common symptom of GERD, which is a burning feeling rising from the stomach or lower chest up towards the neck. Other symptoms include regurgitation (food may come up into the mouth), chest pain, a difficulty in swallowing (a condition called dysphagia), hoarseness and asthma. If untreated, severe heartburn can reduce quality of life for sufferers. In severe cases of oesophagitis, the lining of the oesophagus may become ulcerated, leading to pain and possible narrowing due to scarring (making the swallowing of food and sometimes even liquids difficult).

In people with esophagitis, there may be an increased risk of cancer of the esophagus. Stomach acid also plays a significant role in the development of peptic ulcers that can result in serious complications like bleeding and perforation of the stomach wall.

How long does GERD last?
The symptoms of GERD are frequent and may last several weeks, months or longer if left untreated. They can also re-occur after treatment.

How is GERD treated?
Medications commonly used in the treatment of GERD include:

  • Acid suppressants, such as histamine H2-antagonists (blockers). Histamine is a chemical released in the body under many different conditions. In the stomach it can release more acid, so blocking histamine’s action reduces acid production.
  • Proton-pump inhibitors also work on the cells in the stomach wall, which make acid, to reduce the amount of acid produced and released into the stomach chamber.
  • Other medicines (called pro-kinetic agents) increase the movement of the stomach. They work by increasing the pressure of the lower esophageal sphincter (the point where the esophagus joins the stomach) and promote emptying of the stomach.
  • Antacids are medicines that are commonly used to treat acid-related symptoms, like heartburn or indigestion, and work by neutralising acid in the stomach. However, they are not usually recommended to treat the frequent heartburn suffered by people with GERD.

Living with GERD/Acid reflux
If you have symptoms of GERD you should consult your doctor, who can confirm the diagnosis and provide you with a treatment plan. Avoiding factors, which make acid reflux worse may help reduce the symptoms of GERD but is not an alternative to treatment.

  • You may find it useful to keep a diary of your symptoms and the food you eat, so that you can see which foods affect you.
  • Avoid eating too close to bedtime. Try to leave at least two to three hours after a meal, before you go to bed.
  • Avoid lying down after meals.
  • Eat small regular meals.
  • Do not wear tight clothing, which may increase the pressure on you stomach.
  • Raising the head of your bed by four to six inches may help reduce nighttime acid reflux.

Hiatal Hernia

A hiatal hernia is caused by a weakness or stretching of the hiatus (an opening for the esophagus) located in the diaphragm (the broad, thin muscle separating the chest cavity and abdominal cavity). When this opening becomes weakened, gastric (stomach) acid flows backward from the stomach into the esophagus, irritating the esophagus. The stomach may even protrude into the lower chest.

Frequent signs and symptoms:
The following symptoms usually develop within 1 hour or more after eating:

  • “Heartburn” (a burning sensation in the area of the heart and behind the breastbone). May be confused with heart attack symptoms.
  • Belching.
  • Swallowing difficulty (rare)

Risk increases with:

  • Congenital weakness in the muscular ring of the diaphragm through which the esophagus passes and empties into the stomach.
  • Abdominal injury, causing tremendous pressure that tears a hole in some part of the diaphragm.
  • Chronic constipation and straining during bowel movements.
  • Obesity.
  • Pregnancy.
  • Constant straining or lifting with tightening of the abdominal muscles.
  • Smoking.
  • Age over 50.

Preventative measures:

  • No specific preventative measures.

Expected outcome:
Symptoms can usually be controlled. If symptoms cannot be controlled and it appears that irritation of the esophagus is causing scarring and ulceration, the condition can be corrected with surgery.

Possible Complications:

  • Bleeding from the esophagus. This can be excessive, leading to shock.
  • Misdiagnosis as a heart attack.

General Measures:
For diagnosis, an esogastroscopy (passage of a viewing tube down the throat into the esophagus) may be performed. If cancer is suspected, a small amount of tissue may be removed for a biopsy. Manometry (pressure measurement) may be performed to confirm the reduced pressure at the esophagogastric junction.

The primary goals of treatment are to relieve symptoms and to manage and prevent complications. Medical therapy is used first with surgery to close the weakness in the diaphragm being reserved for severe cases. You can also help control your symptoms:

  • Raise the head of your bed 4 to 6 inches. This allows gravity to keep stomach acid away from the hernia.
  • Don’t smoke
  • Don’t wear tight pantyhose, girdles, belts or pants.
  • Don’t strain during bowel movements, urination or lifting.
  • Don’t bend over or lie down immediately after a meal.
  • Avoid large meals. Eat 4 or 5 small meals a day instead. Don’t eat anything for at least 2 hours before bedtime.
  • Lose weight, if you are overweight. Frequently symptoms may disappear below a specific weight.
  • Avoid alcoholic beverages, caffeine-containing beverages (coffee, tea, cocoa, cola drinks) and any other food, juice, or spice that aggravates symptoms.
  • Eat slowly.

Antacids are most effective for some persons when they take them 1 hour before meals and at bedtime, however, others find them more helpful 1 to 2 hours after meals and at bedtime. Try both ways to find the best schedule for you. You may also be prescibed stool softeners and/or drugs which hasten gastric (stomach) emptying.

Notify our office If:

  • You or a family member has symptoms of a hiatal hernia, especially the sensation that food stops beneath the breastbone. Call immediately if pain is accompanied by shortness of breath, sweating, or nausea.
  • You vomit blood or have recurrent vomiting.
  • Temperature rises over 100 degrees Fahrenheit.
  • Symptoms don’t improve in 1 month with treatment.

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