What is GERD?
Gastro-esophageal reflux disease, known as GERD (or GORD when using the “oesophageal” spelling), is a chronic symptom of mucosal damage produced by the abnormal reflux of gastric contents into the esophagus. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter, its transient relaxation, or association with a hiatal hernia.
Gastric regurgitation is an extension of this process with retrograde flow into the pharynx or mouth.
Symptoms of GERD
* Heartburn is the major symptom of acid in the esophagus, characterized by a burning discomfort behind the breastbone. It also includes strictures, difficulty swallowing and chronic chest pain. Patients may have only one of these findings, and some patients may be experiencing more. Atypical symptoms of GERD include cough, hoarseness, and changes of the voice, chronic earache, or in some cases sinusitis. Complications of GERD include stricture formation, Barrett's esophagus, esophageal ulcers, and possibly even esophageal cancer. Occasional heartburn is common but does not necessarily mean one has GERD, although patients that have heartburn symptoms more than once a week are at risk of developing GERD.
Heartburn is also known as acid indigestion. It is the most common symptom of GERD and many people say it feels like food is coming back into the mouth leaving an acidic or bitter aftertaste. The burning, pressure, or pain of heartburn can last as long as 2 hours and is often worse after eating, when lying down or bending over can also result in heartburn. Many people obtain relief by standing upright or by taking antacids, which clears acid out of the esophagus. Heartburn pain can easily be mistaken for the pain associated with heart disease or a heart attack, but there are differences. Exercise may aggravate pain resulting from heart disease, rest may relieve the pain, and heartburn pain is less likely to be associated with physical activity.
* A hiatal hernia is usually asymptomatic, but the presence of a hiatal hernia is a risk factor for development GERD as well
Diagnosis of GERD
A detailed medical history is vital to diagnosing your problem with acid reflux and heartburn. Useful investigation methods may include barium swallow X-rays, esophageal manometry, esophageal pH monitoring, and esophagogastroduodenoscopy. In general, an EGD is a great choice when the patient does not respond well to treatment. It is also useful when a patient has had symptoms or required medications for a prolonged time, generally 5 years. If patient is complaining about dysphagia, anemia, blood in the stool, weight loss, and/or changes in the voice, this is also a good diagnostic method.
Biopsy is commonly performed following gastroscopy, and may show edema and basal hyperplasia as non-specific inflammatory changes. Furthermore, it can show lymphocytic inflammation, neutrophilic inflammation, eosinophilic inflammation, goblet cell intestinal metaplasia, or Barrett’s esophagus. This diagnostic method could also show dysplasia or pre-cancer, and even carcinoma. Rapid testing assays can quickly detect the presence of Helicobacter pylori in a biopsy sample through urease testing.
How to treat acid reflux and heartburn?
First, you must try to avoid aggravating factors. Certain types of food and lifestyle choices tend to promote gastro-esophageal reflux. Coffee, alcohol, calcium supplements, and excessive amounts of vitamin C supplements are known stimulants of gastric acid secretion. Taking these supplements, before bedtime especially, can promote evening reflux. Smoking and a diet high in fat reduce lower esophageal sphincter competence, so avoiding both of these. Fat also delays emptying of the stomach, which is very important for anyone who suffers from acid reflux and heartburn. Having more but smaller meals also reduces the risk of GERD, because smaller meals mean there is less food in the stomach at any one time.
To relieve possible symptoms, try to avoid eating for 2 hours before bedtime, and elevate the head of the bed on 6-inch blocks. Pillows under the Head and shoulders were ineffective. You should also avoid sodas that contain caffeine, and also chocolate, peppermint, spicy foods, and acidic food like oranges and tomatoes. Furthermore, to prevent acid reflux and heartburn you should avoid cruciferous vegetables such as onions, cabbage, cauliflower, broccoli, Brussels sprouts, milk, and milk-based products (since they contain both calcium and fat). You should especially try to avoid these before bedtime. Avoiding all food for 2 hours before bedtime and not lying down after a meal are the most important of lifestyle modifications for GERD patients.
What kind of drug treatment is available for acid reflux and heartburn?
A number of drugs registered for the treatment of GERD are among the most-often-prescribed forms of medication in most Western countries. These medicines are common in combination with other drugs, although some antacids can impede the function of other medications. Antacids used before meals or symptomatically can reduce gastric acidity by increasing the pH. Alginic acid may coat the mucosa as well as increase pH and decrease problematic reflux. Ranitidine or famotidine can reduce gastric secretion of acid since these drugs are technically antihistamines. They relieve complaints of most symptoms in about 50% of all GERD patients. Proton pump inhibitors, such as Omeprazole, are effective in reducing gastric acid secretion. The reason is that they stop the secretion of acid at the source of acid production, i.e. the proton pump. To maximize effectiveness of this medication, the drug should be taken half an hour before a meal.
Surgical treatment of GERD
A standard surgical treatment, sometimes preferred over longtime use of medication, is known as Nissen fundoplication. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux. This procedure also repairs a hiatal hernia, where doctors use laparoscopic way.
An obsolete treatment is vagotomy, or highly selective vagotomy. This is the surgical removal of vagus nerve branches, which innervate the stomach lining. This treatment is not so common lately, and most doctors prefer medication therapy.
Other treatments of GERD
In 2000, two endoscopic devices were approved to treat chronic heartburn and acid reflux in GERD patients. One system, Endocinch, puts stitches in the LES to create little pleats to help strengthen the muscle. Another one, the Stretta Procedure, uses electrodes to apply radio frequency energy to the LES. The long-term outcomes of both procedures compared to a Nissen fundoplication are still being determined. Another treatment, which involved injection of a solution during endoscopy into the lower esophageal wall, was available for approximately one year ending in late 2005, and known by the name Enteryx. However, it not on the market any more due to several reports of complications relating to misplaced injections.
Some people have found success using dietary changes to treat their own acid reflux and heartburn symptoms.
Some common side effects of heartburn medicines
Antacids and acid reducers usually cause only minor side effects that go away on their own in time. These side effects may include headaches, nausea, constipation, or diarrhea. Bismuth subsalicylate can cause a patient’s tongue or stool to turn dark. This is a short-term side effect, so it should not worry you. If side effects make it hard for you to take medicine for heartburn, you should talk to your doctor. He or she may suggest a different drug or have ideas about how to make the side effects less of a problem during therapy.
Who should NOT take antacids and acid reducers?
Any patient who has an allergy to any of the ingredients in these drugs should not use them. Phenylalanine is an example of an ingredient in some antacids that can cause a problem for some people, so you have to be careful. If you have a condition called phenylketonuria, you should not take a medicine that contains phenylalanine. Do not take Bismuth subsalicylate if you have ever had an allergy to Aspirin or any other product that has salicylates ingredients. It is also important not to give Bismuth subsalicylate to children who may have the flu or chickenpox, because they will have a higher risk of Reye’s syndrome.
Other ingredient-related warnings concern your diet while you are taking an antacid or acid reducer to relieve your symptoms. Try to avoid magnesium hydroxide if you are following a magnesium-restricted diet. Furthermore, if you have kidney disease, you should not use products containing calcium carbonate, aluminum hydroxide, or magnesium carbonate without your doctor’s recommendation.