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March 16th, 2018


GERD - What You Should Know

 

 What Is GERD?

GERD or Gastro-Esophageal-Reflux Disease is a digestive system disorder marked by backward flow of stomach acid, and sometimes bile and pancreatic products, upward into the esophagus.

 

GERD Symptoms

GERD symptoms are of two types: typical and non-typical.

The typical symptoms are digestive symptoms such as heartburn, regurgitation with sudden acidic taste in the mouth, and sudden occasional difficulty swallowing.

 

The atypical symptoms are those often associated with respiratory problems, such as asthma, pneumonia, laryngitis, hoarseness, nighttime coughing, and even dental enamel erosion.

 

Demographics of GERD

GERD has been estimated as affecting, at some time and in some degree, upwards of 25% of Americans. Further, the incidence has been rising in recent years. GERD seems to be more common in Caucasian Americans than in African Americans and is also more common in persons older than 40 years..

 

GERD Risk Factors

Obesity is the most important risk factor in GERD. However, other risk factors are smoking, alcohol, high dietary fat, and increased gram-negative bacteria in the GI tract. Finally, hiatal hernia is a frequent cause of GERD.

 

Causes of GERD 

The esophagus is often called the “food tube,” but this is inappropriate. It suggests that swallowing is a passive procedure, like clothes falling down a laundry chute into a basket in the basement.  

 

Actually, it is movements in the esophagus that propel food along toward the stomach. A sort of valve called the lower esophageal sphincter or LES separates the esophagus and the stomach, helping to keep the stomach contents from returning into the esophagus. Another valve, the pylorus. separates the stomach from the intestines and keeps contents of the intestines, including bile and pancreatic secretions, from returning to the stomach.

 

GERD may be caused when the esophagus does not adequately propel food toward the stomach, when the LES does not adequately keep stomach contents from returning to the esophagus, when the stomach remains too full of contents too long, when bile and pancreas secretions reflux from the small intestine into the stomach and then into the esophagus, or when there is a hiatal hernia.

 

A hiatal hernia permits the migration of part of the stomach from the abdomen into the chest. One of the ways that hiatal hernia can cause GERD is by allowing retention of food into the part of the stomach herniated into the chest.

 

There is another, more sophisticated mechanism by which part of the stomach moving into the chest causes GERD. Here the stomach moving into the chest takes the LES with it. But, the pressure in the chest is negative, this allows the lungs to inflate during breathing. The negative pressure outside the LES assists keeping it open, allowing reflux of gastric contents into the esophagus.

 

Complications of GERD

The most serious complications of GERD are esophagitis, stricture, and Barret esophagus.

 

Esophagitis is damage to the internal lining of the esophagus on continuing exposure to reflux. It occurs in about 50% of untreated GERD patients.

 

Stricture is a narrowing of the esophagus due to deeper tissue injury. It can result in difficulty swallowing and vomiting of undigested food. This typically requires surgical consultation.

 

Barrett esophagus is the most serious complication and affects 8-15% of untreated GERD patients. It changes the character of the lower esophageal lining cells to somewhat resemble those of stomach lining cells. Barrett esophagus increases the risk of esophageal cancer 30-40 times. Barrett esophagus also needs surgical consultation.

 

Treatment of GERD 

Treatment of GERD typically depends on severity and falls into three categories: lifestyle changes, medication, and surgery.

 

Lifestyle changes include

  •      Losing weight
  •      Stopping smoking
  •      Avoiding alcohol, chocolate, citrus, and tomato along with peppermint, coffee, and onion.
  •      Avoiding large meals
  •      Waiting 3 hours after meals before reclining
  •      Elevating the head of the bed by 8 inches
  •  

Medications include

  •      Antacids
  •      Histamine-2 receptor blockers such as ranitidine, cimetidine,famotidine, and nizatidine.
  •      Proton pump inhibitors such as omeprazole, lansoprazole, rabeprazole, and esomeprazole.

 

Surgery

  •      The most common surgery is the Nissen fundoplication, in which a portion of the upper stomach is sutured around the lower part of the esophagus to strengthen the function of the LES.

 

Conclusion

The most important things to remember are that GERD is common, that there are effective treatments for GERD, and that GERD should not be ignored. Left untreated, GERD can result in such serious problems as esophageal stricture and esophageal cancer. Nevertheless, your physician can offer effective treatments for GERD.

 

Thomas Falasca, DO

 

 

References

 

Anand G, Katz PO. Gastroesophageal reflux disease and obesity. Gastroenterol Clin North Am. 2010 Mar. 39(1):39-46.

 

Heartburn across America: a Gallup Organization national survey. 1988.

 

Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007 Mar. 11(3):286-90.

 

Loffeld RJ, van der Putten AB. Rising incidence of reflux oesophagitis in patients undergoing upper gastrointestinal endoscopy. Digestion. 2003. 68(2-3):141-4.

 

Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976 Nov. 21(11):953-6.

Patti, M. (2017, October 17). Gastroesophageal Reflux Disease. Retrieved December 07, 2017, from http://emedicine.medscape.com/article/176595-overview

 

Shaheen N, Provenzale D. The epidemiology of gastroesophageal reflux disease. Am J Med Sci. 2003 Nov. 326(5):264-73.

 

 

 
 
 
 

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