Gastro-Esophageal Reflux Disease (GERD)
Gastro esophageal reflux disease (GERD) is a chronic symptom of mucosal damage that is caused due to entry of acid from stomach into the esophagus. The esophagus is a long tube of muscle than runs from the mouth to the stomach. Normally once the food is chewed, it goes from the mouth to the esophagus and then into the stomach, where it is mixed with the acidic gastric juice for digestion. The esophagus and the stomach are separated by a sphincter (lower esophageal sphincter), which is a band of muscular fibers that close the valve in order to prevent the food or gastric acids from going back to the esophagus.
Symptoms
The most-common symptoms of GERD are:
Heartburn
Regurgitation
Difficulty in swallowing (dysphagia)
Heart burn: Heartburn is a burning pain or a feeling that develops just below the breastbone. The pain is usually worse after eating, or while bending over or lying down.
Regurgitation: Expulsion of acid usually causes an unpleasant, sour taste at the top of your throat or the back of the mouth.
Dysphagia: Dysphagia is usually characterized by difficulty in swallowing.
Causes
GERD usually manifests due to problem with the lower esophageal sphincter (LES) muscle. The LES is located at the bottom of the esophagus, the tube that runs from the back of throat to stomach.
The most common risk factors of GERD are as follows:
Obesity
Consuming caffeine: in form of chocolates, coffee.
Pregnancy
Having diet rich in fatty acids
Stress
Hiatus Hernia (It occurs when part of the stomach pushes up through the diaphragm)
Diagnosis
Diagnosis of GERD is uaually accompanied with an accurate symptomatic history. It can be diagnosed by procedures like Endoscopy, Barium swallow and Manometry.
Endoscopy: It is a procedure in which fibre-optic tube is inserted into the stomach. To confirm a diagnosis of GERD, the endoscope is inserted into mouth and down into the throat. The procedure is usually done while the patient is awake, and may be given a sedative to relax. An endoscopy is used to check whether the surface of esophagus has been damaged by stomach acid. It can also rule out more serious conditions that can also cause heartburn, such as stomach cancer.
Barium swallow: If there are symptoms of dysphagia then patient may be referred for a test known as barium swallow. The barium swallow test is one of the most effective ways of assessing the swallowing ability and finding exactly where the problems are occurring. The test can often identify blockages or problems with the muscles used during swallowing.
Manometry: Manometry is used to assess how well lower esophageal sphincter (LES) is working by measuring pressure levels inside the sphincter muscle. During the test, patient will be asked to swallow some food and liquid to check the proper functioning of LES.
Treatments
Self-care is very essential for treating GERD. It includes:
Losing weight if patient is obese
Eating less and more frequently
Be aware of triggers that leads to GERD like caffeine, tobacco.
Medications: A number of medications like:
Proton-pump inhibitors (PPIs)
H2-receptor antagonists
Prokinetics
Surgery: The standard surgical treatment for severe GERD is the Nissen fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux and also to repair a hiatal hernia.
Complications
Esophageal ulcers are one of the most common complications of GERD. The excess acid produced by gastro-esophageal reflux disease (GERD) can damage the lining of esophagus (esophagitis) which can lead to the formation of ulcers. The ulcers can bleed, causing pain and making difficult in swallowing. Ulcers can usually be successfully treated by controlling the underlying symptoms of GERD.
References:
NCBI
CDC
NHS
U S National Library of Science
