Gastroesophageal Reflux Disease: Causes, Treatment and Prevention
The retribution for your ruinous lifestyle and eating habits!!!
Dr. M.v. Annalarasi
February 2, 2018
The condition of Gastroesophageal Reflux Disease (GERD) is more common a problem than we realize. Heartburn is reported at least once a month by 40% of the Americans and almost every day by around 7–10%. According to the World Gastroenterology Organization (2015), the prevalence of GERD worldwide is increasing. It is from 2.5% to 6.6% in Eastern Asia and 13.8% to 25.8% in North America. The reason is not entirely corroborated by facts but speculated that it might be due to obesity and dietary factor due to an unavoidable correlation between them
What is Gastroesophageal Reflux Disease?
The current understanding of the concept and terminology of Gastroesophageal Reflux Disease or GERD is that it is a group of conditions sharing the similarity of gastroesophageal reflux (regurge of food contents or gastric acid from the stomach into the food pipe) causing troublesome symptoms or some other potential esophageal and extraesophageal diseases.
Gastroesophageal Reflux Disease Causes
The commonest disorder of this group is esophagitis, or an inflammation of the food pipe caused due to the reflux of the contents mentioned before, that erode the food pipe. Some amount of belching is of course physiological and normal. The trouble arises only when there is an excessive reflux.
The mechanism behind the reflux is the incompetence of a sphincter at the junction of the food pipe and the stomach. To delve slightly into the medical facts, the incompetence is majorly caused by transient relaxations (a vasovagal reflex) followed by the sphincter hypotension, or in some cases anatomical damage of the junction as in a hiatus hernia (herniation of the stomach through the diaphragm into the chest).
The other causes of esophagitis include excessive consumption of painkillers, infections (AIDS) or after drinking corrosive acids, household bleaching powder etc.,
Gastroesophageal Reflux Disease risk factors
The factors or conditions listed below can further increase the uncomfortableness associated with the condition
- Consumption of excessive junk foods, coffee, chocolates and the like
- Cigarette smoking and alcohol
The condition of Gastroesophageal Reflux Disease, occurs in conjunction with several other disorders, in the esophagus or away from the esophagus. This wide range of conditions include chronic cough and bronchitis, laryngitis, asthma, dental erosions, sleep apnea, pharyngitis, pulmonary fibrosis, chronic sinusitis, cardiac arrhythmias, and recurrent aspiration pneumonia
Gastroesophageal Reflux Disease Symptoms
- Pain in the epigastric region (upper central abdominal region)
- Difficulty in swallowing
- Heartburn and regurgitation( most often increased on bending, straining or lying down)
- Water brash or increased saliva in mouth
- Sensation of lump in throat
- Chest pain (sometimes right sided)
And the condition is always not a simple one to treat. The Alarm symptoms of Gastroesophageal Reflux Disease are:
- Painful swallowing of food
- Unexplained weight loss
- Repeated Vomiting and indigestion
- Non-visible Bleeding from the gastrointestinal tract resulting in a positive fecal blood test or sometimes iron deficiency anemia
- Any visible mass/ swelling in the abdomen
- Family History of any gastrointestinal malignancies
Gastroesophageal Reflux Disease Investigations
For the diagnosis of Gastroesophageal Reflux Disease, the most recommended test is a 24-hour ambulatory monitoring of the pH levels. This test evaluates how often the acid from the stomach regurgitates into the food pipe and to find out if this acid is related to the symptoms. The food pipe or esophagus has a muscle at the entrance to the stomach to keep the food from coming back up into the esophagus. If this valve does not work properly, the symptoms of heartburn or pain occur. Endoscopy is done in those patients with the alarm symptoms
When the condition of esophagitis persists for a very long time, it can cause bleeding and strictures. Also, a condition called the Barret’s Metaplasia occurs that progresses over to Adenocarcinoma (cancer).
Can Gastroesophageal Reflux Disease be cured?
Drugs are available over-the-counter agents for milder symptoms. Antacids and histamine H2 antagonists decrease the symptoms of Gastroesophageal Reflux Disease. Antiflatulents and adsorbents are given to reduce gaseous symptoms. Acid-lowering therapy like proton pump inhibitors would also be given, especially in patients affected by the condition of Gastroesophageal Reflux Disease for a long time. This class of drugs: omeprazole, lansoprazole, rabeprazole, and pantoprazole show similar efficacy in suppressing or neutralizing the acid secreted. These medications are also available over-the-counter.
The management of the complications is a different strategy altogether. It is best advised to visit a physician when the milder form of symptoms occur and not to postpone the visit.
Another important point to be noted is that the drugs are recommended for milder symptoms, if and only if the prevention strategies mentioned below do not work. Long-term therapy with these drugs come with their own share of debilitating side effects. Hence, it is strongly advised to avoid overuse of the drugs, especially when bought over the counter.
Gastroesophageal Reflux Disease Prevention
This methodology of approach is even better. Prevent the condition. Lifestyle and dietary modification is a good venture. Avoiding fatty foods and consuming less alcohol, coffee, avoiding meals before sleep and getting a refreshing sleep. In those who experience the symptoms at night, it is advised to sleep with their heads elevated a bit. Another major step towards is to exercise regularly and avoid becoming overweight or obese.
Also read about
- Textbook of Harrison’s Principles of Internal Medicine.
- Textbook of Davidson’s Essentials of Medicine.
- Book of Extraesophageal Reflux by Michael F. Vaezi.
- A Practical Guide to Reflux: Causes, Consequences, and Care by John W. Birk.
- GERD: Reflux to Esophageal Adenocarcinoma by Parakrama T. Chandrasoma, Tom R. DeMeester, and Tom R. DeMeester.
- Acid gastroesophageal reflux and intensity of symptoms in children with Gastroesophageal Reflux Disease. Comparison of primary gastroesophageal reflux and gastroesophageal reflux secondary to food allergy III Department of Pediatrics, Medical University of Białystok, Białystok, Poland Semeniuk J, Kaczmarski M.
- Gastroesophageal Reflux Disease and Airway Disease by Mark R. Stein.