Gastroesophageal Reflux Disease
GERD is caused by repeated acid reflux or reflux of stomach content from the stomach
When you swallow, the muscle around the bottom of your esophagus, which is called the lower esophageal sphincter. relaxes to allow food and liquid to flow into your stomach. Then it closes again.
If the lower esophageal sphincter does not relax as it should, stomach acid can flow back into your esophagus causing it to become inflamed.
There are risk factors that lead to high risk of GERD such as:
ObesityPregnancyCertain connective tissue diseases such as sclerodermaSmoking, drinking alcohol and excess coffee can cause it tooSymptoms:
Early signs and symptoms of GERD include:
A burning sensation in the chest or heartburn after eatingRegurgitation of food or sour liquidAbdominal pain or chest painDifficult swallowing An ongoing coughInflammation of the vocal cords (laryngitis)New or worsening asthmaDiagnosis:
Diagnosis of GERD can be done based on history and symptoms, however your doctor can also obtain some more tests to confirm the diagnosis such as:
Upper endoscopy: which is done using a small camera mounted in a flexible tube to see inside your stomach and esophagus, it helps in assessing the severity of the inflammation and also to collect a sample of the tissues to send to the lab.
Ambulatory acid pH probe test: which is a small probe that will be inserted through the nose to the inside of your stomach to identify the degree of acidity, for how long the acid regurgitates to the esophagus. This probe is attached to a small device that is placed around your shoulder or waist for a period of time.
Swallow study, which is done using X-ray taken after your drink a chalky liquid that fills the inside of your esophagus and stomach, the x-ray will help identify an problems with swallowing of filling defects.
Esophageal manometry: which is a test that measure the contraction of the esophageal muscles when you swallow. This helps identify and measure the coordination of contraction while swallowing.
Treatment:
The treatment initially includes lifestyle changes, and if there is no improvement within a few weeks, then your doctor might prescribe some medications for you. These medications can include:
Antacids: these are medications that contain calcium carbonate and they neutralize the stomach acid. Overusing antacids can cause side effects such as diarrhea.
Medications that decrease stomach acid production, these are known as Histamine H2 blockers. They don’t act quickly; however, they can provide longer relief of symptoms.
Medications that block acid production and help healing the esophagus: these are known as proton pump inhibitors: these are stronger than Histamine blockers and allow the inflamed esophagus to heal.
If all medical management fails, your doctor may recommend surgical procedures to manage your GERD such as:
Fundoplication: in this procedure the surgeon will wrap the top of your stomach around the lower esophageal sphincter and tighten the muscle to prevent reflux. There are different variations of this procedure and your surgeon will decide what is best for you.
LINX device: which is a magnetic device that gets wrapped around the junction between the esophagus and the stomach to make it tight enough to prevent acid reflux but at the same time allow passage of food during swallowing.
Prevention:
Lifestyle changes may help reduce the frequency of GERD and improve the symptoms. These changes include:
Maintain healthy body weight, avoid obesity and exercise regularly
Stop smokingLimit alcohol and coffee drinkingElevate the head of your bed during sleepingStart sleeping on your left side when you go to bed, to help avoiding reflux as you go to sleepDon’t sleep or lie down after a mealEat food slowly and chew wellAvoid foods that trigger acid reflux such as: chocolate, fatty foods and peppermint
