GERD or Gastroesophageal Reflux Disease is a situation in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This act can rub the esophagus in the wrong way, causing heartburn and other symptoms. The esophagus is a long tube of muscle than runs from the mouth to the stomach.
Causes of GERD or Gastroesophageal Reflux Disease
Significant factor in GERD is the Lower Oesophageal Sphincter (LOS) muscle not working properly. The LOS acts like a valve, opening to let food fall into the stomach and closing to prevent acid leaking out of the stomach and into the esophagus. In cases of GERD, the LOS does not close properly, allowing acid to leak up out of the stomach.
Difference between Heart Burn and Acid Reflux
There is dissimilarity between Heartburn and Acid Reflux. Acid reflux is the action, while heartburn is the sensation. The pain is heartburn, whereas the movement of acid into the esophagus from the stomach is acid reflux.
- Acid reflux takes place when stomach acid reiterates up into the esophagus. Reflux can be one of the causes of heartburn. However, no pain at all may be felt when reflux occurs.
- Heartburn is a feeling of tightness, pain or discomfort in the center of the chest that can trail an occurrence of acid reflux or otherwise. Heartburn is exactly what it would feel like if acid ate away at the lining of your esophagus, because that’s what’s happening.
Reflux Symptoms or Gastro Esophageal Reflux Disease Symptoms
Signs and symptoms may include:-
- Heartburn. A burning feeling in your chest (heartburn), sometimes extending to the throat, together with a sour taste in your mouth
- Asthma. Gastric juices ooze upwards into the throat, mouth and air passages of the lungs
- Chest pain. Part of the heartburn sensation
- Dental erosion
- Dysphagia. Difficulty in swallowing
- Hoarseness or sore throat
- Regurgitation. Conveying food back up into the mouth
- Sensation of a lump in the throat
Risk Factors of Gastro Esophageal Reflux Disease (GERD)
Following factors may increase your risk of contracting GERD:-
- Hiatal hernia
- Dry Mouth
- Delayed stomach emptying
- Connective tissue disorders, such as scleroderma
- Zollinger-Ellison syndrome
Diagnosis of Gastro Esophageal Reflux Disease (GERD)
- Esophagogastroduodenoscopy (EGD) is frequently used to stumble on the cause and inspect the esophagus for damage. The doctor pop in a thin tube with a camera on the end through your mouth. The tube is then passed into your esophagus, stomach, and small intestine.
- Barium Swallow
- Esophageal pH monitoring
- Esophageal Manometry
- A biopsy may be taken during endoscopy to check samples of tissue under a microscope for infection or abnormalities.
Treatment of Gastro Esophageal Reflux Disease (GERD)
- Diet. Certain foods and lifestyle are considered to promote gastroesophageal reflux, avoid foods that aggravate GERD.
- Sleeping Posture. Sleeping on the left side has been shown to reduce nighttime reflux episodes in patients and elevating the head of the bed is an effective therapy
- Medications for GERD
- Proton Pump Inhibitors (such as omeprazole, esomeprazole, pantoprazole, lansoprazole, and rabeprazole) are the most effective in reducing gastric acid secretion. These drugs stop acid secretion at the source of acid production, i.e., the proton pump.
- Gastric H2 receptor blockers (such as ranitidine, famotidine and cimetidine) can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all GERD patients. Compared to placebo (which also is associated with symptom improvement), they have a number needed to treat (NNT) of eight (8).
- Antacids before meals or symptomatically after symptoms begin can reduce gastric acidity (increase pH).
- Alginic acid (Gaviscon) may coat the mucosa as well as increase pH and decrease reflux. A meta-analysis of randomized controlled trials suggests alginic acid may be the most effective of non-prescription treatments with a NNT of four.
- Prokinetics strengthen the lower esophageal sphincter (LES) and speed up gastric emptying. Cisapride, a member of this class, was withdrawn from the market for causing long QT syndrome. Reglan (metoclopramide) is a prokinetic with a better side-effect profile.
- Sucralfate (Carafate) is also useful as an adjunct in helping to heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two (2) hours apart from meals and medications.
- Mosapride citrate is a 5-HT4 receptor agonist largely as a therapy for GERD and dyspepsia.
- Baclofen is an agonist of GABAB receptor. In addition to its skeletal muscle relaxant properties, it has also shown to decrease transient lower esophageal sphincter relaxations at a dose of 10mg given four times daily. Reductions in esophageal relaxation clinically reduce episodes of reflux
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