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Gastroesophageal reflux disease

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Gastroesophageal reflux disease (GERD) is a digestive system disease that occurs when acid from the stomach passes the Lower Esophageal Sphincter and gets up into the esophagus.[1] It affects 19 million people around the world,[2] although people are frequently unaware that they have it. If untreated it can eventually lead to cancer.[3] Some people have very mild heartburn on a consistent basis while others have pain that prevents them from eating all that they should. Besides cancer, GERD can also cause Erosive Esophagitis and cause harm to the esophagus. [4] To prevent GERD, people can change some of the foods they eat, take medicines, and even have surgery. [5]

Cause

Lower Esophageal Sphincter
LES Function

Gastroesophageal Reflux Disease occurs when acid from the stomach is released from the Lower Esophageal Sphincter (LES) and comes up into the esophagus. Acid is in the stomach in order to help break down foods and aid in digestion. [6] Though the stomach is made to handle the acid the esophagus is harmed by it. [7] The LES is a ring of an elastic consistency, that is strong and it protects the esophagus from stomach juices. It is closed tightly and opens only a small amount in order to allow food through to the stomach. When a person has GERD, the LES loosens and acid gets up into the esophagus which can eventually cause Erosive Esophagitis. Sometimes people have symptoms of GERD but instead they have asthma, dry cough, or sometimes trouble swallowing. This is very dangerous because the esophagus and other parts of the digestive system can be harmed, and by the time people find out about it, sometimes it is too late. [8] Many people each year are affected by it. It can cause some people to lose their desire to eat because of the pain it causes. Some young children who experience GERD choose to eat only when completely forced and this causes them to be slow in development. Like adults, some children regularly throw-up after eating because their acid reflux is so strong. Sometimes water brash occurs, which is where a person can taste a sour or salty feeling after eating; that is a result of excess reflux. [9]

Symptoms

Heartburn that consistently occurs two or more days a week for at least, three months, may be GERD. [10] Heartburn is caused by the Lower Esophageal Sphincter not closing properly or occasionally opening, allowing stomach acid up into your throat. [11] Asthma is very commonly linked to GERD and when GERD is treated, asthma symptoms tend to reduce. Seventy-five percent of people with asthma, also have GERD. When treating GERD, it often relieves asthma symptoms. The exact link between asthma and GERD is not certain. It may have something to do with the injury to the esophagus causing cough or it may have to do with a nerve that is triggered with reflux that minimizes the size of the throat. [12] Three common factors that tend to make GERD worse are: obesity, pregnancy and smoking.

People with GERD should avoid these foods which cause increased heartburn and are referred to as “trigger foods:”

  • citrus fruits
  • chocolate
  • drinks with caffeine or alcohol
  • fatty and fried foods
  • garlic and onions
  • mint flavorings
  • spicy foods
  • tomato-based foods [13]

Long Term Health Concerns

If acid reflux goes untreated or if the treatment is not strong enough, the lining of the esophagus can eventually become eroded. This is called Erosive Esophagitis (EE). This happens with the continual exposure of acid to the esophagus. The acid comes into the esophagus, wears it away and eventually there are slits in the esophagus.[14] When many of these form, there are tears in the esophagus which shrink, making the esophagus smaller and in turn making it hard to swallow. People with GERD can develop Barrett’s Esophagus which leads to abnormal shaping and coloring of the esophagus and it can later lead to Esophageal cancer.

There are tests you can take to see if it is happening to you or to see how bad your reflux is. The first is the Barium Swallow Radiograph. This is a series of X-rays being taken over a period of time about an hour long. The technician mixes a solution into your drink and the X-rays follow that fluid to see where it goes. It does not detect minor heartburn. Another test is an upper endoscopy in which the doctor numbs your throat, mildly sedates you and sticks a thin tube down your throat which has a camera and a light. It detects if damage has been done to the esophagus. A pH monitoring examination is a test in which the doctor sticks a tube in your throat that is clipped to your esophagus for 1-2 days. It monitors all that happens within the esophagus in that time period. [15]

Treatment

In treating GERD there are several approaches one can take to reduce the severity of the disease. Someone can treat the problem with lifestyle and dietary changes, medications, and surgery.

When a person is making lifestyle changes they may begin by raising the head of their bed 6” with wood blocks or by not eating between 2 and 4 hours before one lays down to sleep. Doctors suggest eating smaller, more frequent meals and people should avoid their “trigger foods.” [16]

There are many medications available to soothe GERD and protect the esophagus. If a person’s GERD is not too severe they may take antacids to neutralize their acid in the stomach, H2 blockers will block limited forming of acid and protect the esophagus. [17] Prokinetics strengthen the LES and make the stomach empty faster. Foaming agents cover the stomach contents with foam and Proton Pump Inhibitors are the most effective because they relieve heartburn and heal the esophageal lining in most cases of GERD.

Surgery is also an option to making GERD a less severe thing for most people. In the surgery called, Fundoplication, the upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent reflux. In the Nissen Fundoplication, an instrument is inserted through tiny incisions in the abdomen and the small instruments have cameras which guide the doctors. An endoscopic technique is to put stitches in the LES to create pleats that strengthen the muscle making it stronger and more capable of preventing reflux into the esophagus. [18]

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