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Gastro-Esophageal Reflux Disease (GORD)

Posted On: February 07, 2020


Gastroesophageal reflux disease (GERD) is a very common health problem around the world. Although studies in the general population are not abundant in some countries, data from other countries suggest that the prevalence of symptoms indicative of this health problem is 10-50%. The disease gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter (LES), valve controlling passage of contents of the esophagus into the stomach is altered or relaxes inappropriately, allowing the contents to still pass the esophagus again, thus irritating the mucosa to cause symptomatology and characteristic complications.

Gastroesophageal reflux is different from hiatal hernia but both diseases make feeding very difficult, producing very annoying symptoms. Patients suffering this disease experience symptom like heartburn, cough or asthma, fiery sensation in the middle of the chest that occurs after eating, followed by a bitter or sour taste, as well as hoarse or raspy voice. Undoubtedly, this disease has been a big problem in the lives of many who constantly experience heartburn as the most common symptom of GERD. Researches have shown that one (1) out of five (5) Americans suffer heartburn once a week.

According to a statistical report by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 20% population of people in the U.S. experience gastroesophageal reflux symptoms every week. In reports of the same National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in 2010, 4.7 million hospitalizations and 1,653 deaths were recorded as a result of this GERD.

What Is Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is the passage of gastric contents into the esophagus in the absence of nausea, vomiting or belching. It is usually acidic, although in special circumstances it can be alkaline. A certain degree of reflux is a postprandial physiological phenomenon, which appears as a consequence of transient relaxation of the lower esophageal sphincter. If episodes of reflux are more frequent or prolonged, they can trigger GERD. The clinical spectrum of GERD is very varied since the presence of symptoms, the existence of lesions and gastroesophageal reflux in pathological amounts do not occur uniformly.

According to the U.S. National Library of Medicine, Gastroesophageal reflux disease (GERD) is “an ongoing condition in which the contents of the stomach come back into the esophagus”. Heartburn is very common and almost everyone has suffered on occasion, although there are people who suffer permanently. Its appearance is associated with age, overweight and obesity and poor eating habits due to the intake of very seasoned foods, or difficult digestion and other inappropriate actions, such as lying down after meals

Symptoms of Gastroesophageal Reflux Disease (GERD)

The most characteristic symptoms of GERD are the following:

Heartburn or Acid Regurgitation: The most common cynical manifestation of heartburn is the sensation of gastroesophageal reflux. The acidity is a burning sensation, also known as heartburn, which is felt behind the breastbone, and occurs when the gastric contents pass the esophagus producing a mucosal irritation. The acid regurgitation in the chest as gastric fluids rise can reach up to the mouth.

Other Symptoms: which are less common, may be related to some pathologies such as; chest pain, gasps, sore throat, aphonia from irritation caused by acid content in the larynx, cough, asthma or respiratory distress caused by the aspiration of acid through the respiratory tract, etc.

Also, patients who have these pathologies are usually present with gastric fullness (feeling of being very full) or regurgitation (food goes up to the mouth). If the acidity is very serious, it can cause long-term complications from exposure to acid, such as the increase of peritumoral lesions in the esophagus.

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Causes of Gastroesophageal Reflux Disease (GERD)

The gastroesophageal reflux disease (GERD) happens whenever there is a disturbance between the defense mechanisms of the esophagus and stomach offensive mechanisms. Such disturbance includes acid and sometimes, other digestive juices and enzymes. The passage of food from the esophagus to the stomach is controlled by the lower esophageal valve or sphincter (IAS). Those who have this disease have an alteration in this valve. This is kept open for some time, thus, allowing the passage of content from one area to another.

Some dietary aspects or lifestyles can contribute or increase the risk of gastroesophageal reflux such as:

  • A high intake of alcohol, smoking, high consumption of irritating foods such as chocolate, pepper or spices, mint, coffee, foods high in fat. All this favors the relaxation of the lower esophageal sphincter allowing the passage of stomach contents into the esophagus.
  • Many patients also have a hiatus hernia. Hiatus hernia consists of moving part of the stomach to the chest through the diaphragm, favoring gastroesophageal reflux. This is not the only cause since not all people who have hiatus hernia have reflux.
  • On the other hand, other situations that produce an increase in intra-abdominal pressure that may favor such reflux include overweight or obesity, pregnancy, etc.

Diagnosis of Gastroesophageal Reflux Disease (GERD)

The main symptoms that lead to the diagnosis of gastroesophageal reflux disease are acidity and acid regurgitation. In most cases, no additional exams are necessary before starting treatment. If despite following a treatment the symptoms persist or new symptoms appear such as weight loss, difficulty swallowing or internal bleeding, more specific tests should be evaluated.

Some of these tests necessary to diagnose GERD include:

  • Upper Gastrointestinal Radiographs: This is an X-ray examination of the esophagus, stomach and the first part of the small intestine that allows seeing the existence or not of reflux by administering an opaque oral liquid.
  • Endoscopy: A small tube with a light examines the esophagus, stomach, and duodenum, which is the first portion of the small intestine, to be able to observe the mucosa of the esophagus and detect any possible damage to it.
  • Esophageal Manometry or Esophageal Ph: This test can measure how often stomach acid passes into the esophagus and calculate how long the acid belongs there.

Treatment of Gastroesophageal Reflux Disease (GERD)

The goal of treatment of GERD depends on its clinical or morphological manifestations: to achieve remission of symptoms and cure the disease, avoid recurrences, prevent complications and improve quality of life. Thus, the treatment should include general measures and Pharmacotherapy (drug therapy).

General Measures

Healthcare personnel can recommend different general measures that will contribute to improving the quality of life of patients diagnosed with GERD. Postural measures, changes in lifestyle and avoidance of the consumption of certain drugs are basic.

Among the postural measures, it is worth highlighting the elevation of the head of the bed 15-20 cm, using wooden dowels. Patients are also recommended to avoid episodes of postprandial reflux, not to lie down right after eating; It is advisable to wait at least 2 hours. Different studies indicate that the left lateral decubitus is preferable over the right, since the latter favors reflux.

The importance of dietary measures in GERD is because food and beverages can favor reflux by increasing the acid secretion of the stomach, which can directly irritate the esophagus, relax the lower esophageal sphincter and cause an alteration of gastric emptying. For these reasons, patients should be advised to avoid copious meals, as they favor gastric distention and transient sphincter relaxation, and thereby postprandial reflux. On the other hand, foods rich in proteins and carbohydrates increase the tone of the sphincter, while citrus fruits, chocolate, carbonated drinks, tomatoes, spices, coffee, and fatty foods decrease the sphincter tone or may irritate the esophagus.

Pharmacotherapy

The main aim of pharmacological treatment is to maintain the intragastric pH above 4 at those times when reflux is more frequent. Some drugs can be used to treat this disease pharmaceutically include:

Antacids: These drugs neutralize the refluxed acid by neutralizing gastric pH, inactivating pepsin and increasing the tone of the lower esophageal sphincter. They are administered on-demand to improve daytime symptoms, or after meals; they have a quick but not permanent response. Among its side effects are alterations of the intestinal rhythm.

Prokinetic: They improve the motor activity of the esophagus, increasing the pressure of the lower esophageal sphincter, accelerate the esophageal clearance, increase the pressure of the lower esophageal sphincter and accelerate gastric emptying. They are effective against the symptoms of dyspepsia associated with reflux. Its association with ant secretors gives good results.

H 2 Inhibitors: They are drugs that bind competitively to histamine H 2 receptors in gastric parietal cells, reducing acid secretion by 70%. They are effective in controlling mild or moderate esophagitis symptoms.

Proton-pump inhibitor: These drugs are irreversibly linked to the proton pump of the gastric parietal cell, reducing acid secretion by more than 90%. They are effective in curing endoscopic lesions of the most severe cases of esophagitis. They have also demonstrated their effectiveness in continued therapy and demand in the treatment of GERD symptoms.

Sucralfate: is a protector of the esophageal mucosa that does not act on gastric secretion. It can be combined with other drugs, taking into account that its effectiveness decreases when used with ant secretors.

Conclusion

Gastroesophageal reflux disease GERD occurs when the balance between aggressive factors (acid reflux and reflux power) and mucosal defense mechanisms (esophageal clearance and mucosal resistance itself) is unbalanced. This disease is characterized by symptoms like heartburn, cough or asthma, fiery sensation in the middle of the chest that occurs after eating, followed by a bitter or sour taste as well as hoarse or raspy voice, etc. And it can be treated through postural measures, changes in lifestyle and avoidance of the consumption of certain drugs as a basic treatment, as well as pharmacologically.

 

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