Gastroesophageal Reflux Disease

What is Gastroesophageal reflux disease (GERD)?

GERD, or gastroesophageal reflux disease, refers to chronic acid reflux in the esophagus. Usually, acid reflux is regardedas chronic when it occurs at least two times a week for many weeks.

While temporary health disorders can lead to occasional acid reflux, GERD is a persistent, mechanical condition. This signifies that the mechanisms keeping acid out of the esophagus are not functioning correctly.

Common Symptoms of GERD

The most prevalent signs and symptoms of GERD are:

• Burning feeling in the chest (heartburn), often after eating and could worsen duringthe night or when lying down
• Regurgitation (backwash) of food or sour fluid
• Chest or upper abdominal pain
• Difficulty swallowing (dysphagia)
• A sense of a lump in the throat

People who experience nighttime acid reflux can also have:

• A persistent cough
• Vocal cord inflammation (laryngitis)
• New or aggravating asthma

How to differentiate GERD from other digestive disorders

Distinguishing GERD from the rest of the digestive conditions may be difficult, given their similar symptoms. Disorders like gastritis, peptic ulcers, and gallbladder disease can have the same symptoms as GERD.

Therefore, seeking medical care for an accurate diagnosis is essential. Healthcare professionals can conduct tests such as pH monitoring, endoscopy, or imaging studies to properlydistinguish GERD from other health problems.

Causes & Risk Factors

Causes

GERD results from repeated acid reflux or the reflux of non-acidic stomach contents.

Normally, when swallowing, a rounded band of muscle at the base of the esophagus (lower esophageal sphincter) relaxes to let food and liquid move into the stomach and then shut again. However, if this sphincter fails to relax appropriately or becomes weak, stomach acid couldpour back into the esophagus. This irritates and inflames its lining.

Risk factors

Medical conditions likely to increase the possibility of GERD are:

• Obesity
• Hiatal hernia (a bulge at the top part of the stomach, above the diaphragm)
• Pregnancy
• Connective tissue problems, like scleroderma
• Delayed emptying of the stomach

Additional factors that could worsen acid reflux are:

• Smoking
• Consuming large amounts of meals or eating late at night
• Eating particular trigger foods like fried or fatty foods
• Taking certain beverages, including coffee or alcohol
• Using certain drugs such as aspirin

How pregnancy can increase the risk of GERD

Pregnancy can significantly affect the digestive system, raising the possibility of GERD.Changes in hormones during pregnancy could relax the lower esophageal sphincter (LES), letting the stomach acid move back into the esophagus. Furthermore, the expanding uterus exerts pressure on the stomach, worsening acid reflux.

Gastroesophageal reflux diseaseis common among pregnant women, with an approximation of about 80% experiencing symptoms. Managing GERD during pregnancy entails lifestyle adjustments and the use of antacids recommended by medical professionals.

Complications

Chronic inflammation in the esophagus with time can lead to:

• Esophagitis: This is an inflammation of the esophageal tissue caused by stomach acid breaking down the tissue, leading to bleeding, inflammation, and sometimes ulcers (open sore). Esophagitis could result in pain and swallowing difficulties.
• Esophageal stricture: This is when the esophagus narrows down. Scar tissue can form due to stomach acid, which causes damage to the lower esophagus. As a result, the food passage constricts, making swallowing difficult.
• Barrett's esophagus:This entails precancerous changes in the tissue that lines the lower esophagus due to acid damage. The changesare linked with an increased likelihood of esophageal cancer.

Diagnosis of GERD

The doctor can diagnose GERD depending on the history of symptoms and through a physical exam. To confirm the diagnosis or evaluate the complications, they might also recommend the following diagnostic tests:

• Upper endoscopy:The doctor performs this test by inserting a small flexible tube attached to a light and camera (endoscope) down the throat. The camera enables them to view the esophagus and stomach. While endoscopy might not always detect reflux problems, it can show esophagitis (esophageal inflammation) and other complications.
  
  The providers can also use the procedure to obtain tissue samples (biopsy) to test for conditions like Barrett's esophagus. In cases where a narrowing in the esophagus is detected, it can be dilated or expanded during the upper endoscopy. This helps ease swallowing difficulty (dysphagia).

• Ambulatory acid (pH) probe test: This test involves putting a monitor in the esophagus to measure the frequency and duration of stomach acid regurgitation. The monitoris connected to a small computer worn around the waist or overthe shoulder with a strap.
  
  This monitor can be a tiny flexible tube (known as a catheter) passed through the nose into the esophagus. Alternatively, it may be a clip inserted in the esophagus when performing endoscopy, which is later passed through stool after nearly 2 days.

• X-ray of the upper digestive system: Doctors usually performan X-ray after you take a chalky fluid coating and fill the inner digestive tract lining. The coating enables them to view a silhouette of the stomach and esophagus. This procedure is mainly helpful for individuals experiencing trouble swallowing.
  
  In addition, the provider can ask you to swallow a barium tablet which assists in the detection of the esophagus narrowing that might be disrupting swallowing.

• Esophagealmanometry: Doctors use this test to check the rhythmic muscle contractions in the esophagus during swallowing. It also evaluates the coordination as well as the force the esophageal muscles exert. This procedure is often performed in individuals with swallowing difficulties.
• Transnasalesophagoscopy: Healthcare providers conduct this diagnostic test to check for damage in the esophagus. A small flexible tube equipped with a video camera is inserted through the nose and passed down the throat into the esophagus. The camera displays the images on a video screen for further evaluation.

Treatment for Gastroesophageal Reflux Disease

When it comes to GERD treatment, the healthcare provider will likely suggest starting with lifestyle adjustments and non-prescription drugs. If these options do not provide relief in a few weeks, prescription medications and other tests may be recommended.

Non-prescription medications

The available options are:

• Antacids neutralizing stomach acid: Antacids that have calcium carbonate, like Rolaids, Mylanta, and Tums, can give speedy relief. However, they do not cure an inflamed esophagus that stomach acid has damaged. Also, overuse of certain antacids can lead to side effects, including diarrhea or, occasionally, kidney problems.
  
  
• Medications to lower acid production: Referred to as histamine (H-2) blockers, these drugs include cimetidine famotidine (Pepcid AC), (Tagamet HB), and nizatidine (Axid AR). While H-2 blockers do not respond as fast as antacids, they give longer relief and can reduce stomach acid production for up to 12 hours. Much stronger forms are available through prescription.
  
  
• Medications blocking acid production and healing the esophagus: Referred to as proton pump inhibitors, these drugs are powerful acid blockers compared to H-2 blockers and provide time for the recovery of the damaged esophagael tissue. Non-prescription proton pump inhibitors areomeprazole (Prilosec OTC), lansoprazole (Prevacid 24 HR), and esomeprazole (Nexium 24 HR).

Ensure that you inform your provider if you begin taking non-prescription or over-the-counter medications for GERD.

Prescription medications

• Prescription-strength proton pump inhibitors: Examples of these medications arelansoprazole (Prevacid), esomeprazole (Nexium), omeprazole (Prilosec), rabeprazole (Aciphex), pantoprazole (Protonix) and dexlansoprazole (Dexilant).
  
  While these drugs are usually well tolerated, they may lead to diarrhea, nausea, headaches or, rarely, low levels of vitamin B-12 and magnesium.

• Prescription-strength H-2 blockers: Examples are prescription-strength famotidine and nizatidine. This medication causes side effects that are usually minor and well-tolerated.

Surgery and other procedures

Generally, GERD can be managed with medications. However, if the drugs are not effective or you intend to avoid prolonged use of medicines, the physician can suggest the following surgical options:

• Fundoplication: This involves wrapping the top of the stomach near the lower esophageal sphincter to help constrict the muscle as well as prevent reflux. It is normally performed using minimally invasive (laparoscopic) techniques. The upper stomach wrap could be complete (Nissen fundoplication) or partial. Toupet fundoplication is the most prevalent partial procedure. However, the surgeon will suggest the type that suits your condition better.
  
  
• LINX device: Surgeons perform this procedure by wrapping a ring of small magnetic beads near the junction of the esophagus and stomach. The magnetic attraction is strong such that it maintains the intersection closed to prevent acid reflux while still allowing food to go through. This LINX device is embedded via minimally invasive surgery. Generally, the magnetic beads don't impact airport safety or MRI scans.
  
  
• Transoral incisionless fundoplication (TIF): This is a newer surgical procedure that tightens the lower esophageal sphincter by forming a partial wrap near the lower esophagus with polypropylene fasteners. Doctors perform TIF through the mouth with an endoscope;hence, it does not need surgical cuts. The advantages of this approach arespeedy recovery and higher tolerance.

For people with bigger hiatal hernias, only TIF won't be an option, but it can be combined with laparoscopic hiatal hernia repair if necessary.

Since obesity could contribute to GERD, the doctor may recommenda weight-loss surgical procedure as a treatment option. You should thus discuss with your provider to determine whether you are an ideal candidate for this kind of surgery.

The Role of Diet and Lifestyle in GERD Development

Both lifestyle and diet significantly influence the occurrence and management of GERD. Particular foods and drinks may cause or exacerbate gastroesophageal reflux disease symptoms. Examples are acidic foods, fatty foods, spicy foods, caffeine, carbonated beverages, andalcohol.

Dietary adjustments like avoiding consuming trigger foods, and practicing a healthy eating pattern may aid inthe management of GERD symptoms. Furthermore, lifestyle changes like keeping a healthy weight, not lying down immediately after eating, and raising the head of the bed could as well provide relief.

The Link between Obesity and GERD

Obesity is known as a major risk factor that triggers GERD. Having excess body weight increases stress on the stomach, resulting in more frequent acid reflux. Also, abdominal fat might weaken the lower esophageal sphincter (LES); hence raising the possibility of developing GERD.

Generally, weight loss can significantly improve symptoms associated with GERD by lowering stomach pressure and strengthening the LES.

The Impact of Smoking on GERD Symptoms

Smoking is known to aggravate GERD symptoms. The nicotine present in cigarettes tends to relax the LES, which makes flowing back of the stomach acid into the esophagus much easier. Furthermore, smoking lowers the production of saliva, which generally neutralizes stomach acid. Therefore, it is essential for people with GERD to quit smoking as this can ease the symptoms and promote overall health.