Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD), also known as acid reflux, is a long term condition in which stomach contents rise up into the esophagus, resulting in either symptoms or complications.[5][6] Symptoms include the taste of acid in the back of the mouth, heartburn, bad breath, chest pain, vomiting, breathing problems, and wearing away of the teeth.[5] Complications include esophagitis, esophageal stricture, and Barrett’s esophagus.[5]

Risk factors include obesity, pregnancy, smoking, hiatal hernia, and taking certain medicines.[5] Medications involved may include antihistamines, calcium channel blockers, antidepressants, and sleeping medications.[5] Acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the stomach and the esophagus.[5] Diagnosis among those who do not improve with simpler measures may involve gastroscopy, upper GI series, esophageal pH monitoring, or esophageal manometry.[5]

Treatment options include lifestyle changes; medications; and sometimes surgery for those who do not improve with the first two measures.[5] Lifestyle changes include not lying down for three hours after eating, raising the head of the bed, losing weight, avoiding foods which result in symptoms, and stopping smoking.[5] Medications include antacids, H2 receptor blockers, proton pump inhibitors, and prokinetics.[5][8]

In the Western world, between 10 and 20% of the population is affected by GERD.[8] Occasional gastroesophageal reflux without troublesome symptoms or complications is even more common.[5] The classic symptoms of GERD were first described in 1925, when Friedenwald and Feldman commented on heartburn and its possible relationship to a hiatal hernia.[9] In 1934 gastroenterologist Asher Winkelstein described reflux and attributed the symptoms to stomach acid.[10]

Symptomatology

Adults

The most common symptoms of GERD in adults are an acidic taste in the mouth, regurgitation, and heartburn.[11] Less common symptoms include pain with swallowing/sore throat, increased salivation (also known as water brash), nausea,[12] chest pain, and coughing.

GERD sometimes causes injury of the esophagus. These injuries may include one or more of the following: Reflux esophagitis – inflammation of esophageal epithelium which can cause ulcers near the junction of the stomach and esophagus Esophageal strictures – the persistent narrowing of the esophagus caused by reflux-induced inflammation Barrett’s esophagus – intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus[13] Esophageal adenocarcinoma – a form of cancer[12]

Children

GERD may be difficult to detect in infants and children, since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD.

Of the estimated 4 million babies born in the US each year, up to 35% of them may have difficulties with reflux in the first few months of their lives, known as ‘spitting up’.[14] One theory for this is the “fourth trimester theory” which notes most animals are born with significant mobility, but humans are relatively helpless at birth, and suggests there may have once been a fourth trimester, but children began to be born earlier, evolutionarily, to accommodate the development of larger heads and brains and allow them to pass through the birth canal and this leaves them with partially undeveloped digestive systems.[citation needed]

Most children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true when a family history of GERD is present.[citation needed]

Barrett’s esophagus

GERD may lead to Barrett’s esophagus, a type of intestinal metaplasia,[13] which is in turn a precursor condition for esophageal cancer. The risk of progression from Barrett’s to dysplasia is uncertain, but is estimated at about 20% of cases.[15] Due to the risk of chronic heartburn progressing to Barrett’s, EGD every five years is recommended for people with chronic heartburn, or who take drugs for chronic GERD.[16]

Causes

GERD is caused by a failure of the lower esophageal sphincter. In healthy patients, the “angle of His”—the angle at which the esophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue. Factors that can contribute to GERD:

Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors.[17][18]

Obesity: increasing body mass index is associated with more severe GERD.[19] In a large series of 2,000 patients with symptomatic reflux disease, it has been shown that 13% of changes in esophageal acid exposure is attributable to changes in body mass index.[20]

Zollinger-Ellison syndrome, which can be present with increased gastric acidity due to gastrin production.

A high blood calcium level, which can increase gastrin production, leading to increased acidity.

Scleroderma and systemic sclerosis, which can feature esophageal dysmotility.

The use of medicines such as prednisolone.

Visceroptosis or Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.

GERD has been linked to a variety of respiratory and laryngeal complaints such as laryngitis, chronic cough, pulmonary fibrosis, earache, and asthma, even when not clinically apparent. These atypical manifestations of GERD are commonly referred to as laryngopharyngeal reflux (LPR) or as extraesophageal reflux disease (EERD).

Factors that have been linked with GERD, but not conclusively: Obstructive sleep apnea[21][22] Gallstones, which can impede the flow of bile into the duodenum, which can affect the ability to neutralize gastric acid

In 1999, a review of existing studies found that, on average, 40% of GERD patients also had H. pylori infection.[23] The eradication of H. pylori can lead to an increase in acid secretion,[24] leading to the question of whether H. pylori-infected GERD patients are any different than non-infected GERD patients. A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.[25]

References

  1. ^ Carroll, Will (14 October 2016). Gastroenterology & Nutrition: Prepare for the MRCPCH. Key Articles from the Paediatrics & Child Health journal. Elsevier Health Sciences. p. 130. ISBN 9780702070921. “Gastro-oesophageal reflux disease (GORD) is defined as ‘gastrooesophageal reflux’ associated with complications including oesophagitis…”
  2. ^ “Definition of “gastro-” – Collins American English Dictionary”. Archived from the original on 8 December 2015.
  3. ^ “Definition of “esophagus” – Collins American English Dictionary”. Archived from the original on 8 December 2015.
  4. ^ “reflux noun – Definition, pictures, pronunciation and usage notes – Oxford Advanced American Dictionary at OxfordLearnersDictionaries.com”. Archived from the original on 8 December 2015.
  5. “Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults”. NIDDK. 13 November 2014. Archived from the original on 5 October 2016. Retrieved 13 September 2016.
  6.  Kahrilas, PJ; Shaheen, NJ; Vaezi, MF; American Gastroenterological Association, Institute; Clinical Practice and Quality Management, Committee (October 2008). “American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease”. Gastroenterology. 135 (4): 1392–1413, 1413.e1–5. doi:10.1053/j.gastro.2008.08.044.
  7. ^ Kahan, Scott (2008). In a Page: Medicine. Lippincott Williams & Wilkins. p. 124. ISBN 9780781770354. Archived from the original on 8 September 2017.
  8.  Hershcovici T, Fass R (April 2011). “Pharmacological management of GERD: where does it stand now?”. Trends in Pharmacological Sciences. 32 (4): 258–64. doi:10.1016/j.tips.2011.02.007. 21429600.
  9. ^ Granderath, Frank Alexander; Kamolz, Thomas; Pointner, Rudolph (2006). Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment. Springer Science & Business Media. p. 161. ISBN 9783211323175.
  10. ^ Arcangelo, Virginia Poole; Peterson, Andrew M. (2006). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Lippincott Williams & Wilkins. p. 372. ISBN 9780781757843.
  11. ^ Zajac P, Holbrook A, Super ME, Vogt M (March–April 2013). “An overview: Current clinical guidelines for the evaluation, diagnosis, treatment, and management of dyspepsia”. Osteopathic Family Physician. 5 (2): 79–85. doi:10.1016/j.osfp.2012.10.005.
  12. Kahrilas PJ (2008). “Gastroesophageal Reflux Disease”. The New England Journal of Medicine. 359 (16): 1700–7. doi:10.1056/NEJMcp0804684. PMC 3058591. PMID 18923172.
  13. Wang KK, Sampliner RE (March 2008). “Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus” (PDF). Am J Gastroenterol. 103 (3): 788–97. doi:10.1111/j.1572-0241.2008.01835.x. PMID 18341497. Archived (PDF) from the original on 20 July 2011.
  14. ^ “Spitting Up in Babies”. familydoctor.org. Archived from the original on 8 October 2008.
  15. ^ and Barrett’s Esophagus. Retrieved on 1 February 2009.
  16. ^ “Patient information: Barrett’s esophagus (Beyond the Basics)”. June 2009. Archived from the original on 8 September 2017.
  17. ^ Sontag SJ (1999). “Defining GERD”. Yale J Biol Med. 72 (2–3): 69–80.  10780568.
  18. ^ Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). “Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?”. Am J Gastroenterol. 102 (10): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x.
  19. ^ Ayazi S; Crookes PF; Peyre CG; et al. (2007). “Objective documentation of the link between gastroesophageal reflux disease and obesity”. Am J Gastroenterol. 102 (S2): 138–9. doi:10.1111/j.1572-0241.2007.01491_1.x. Archived from the original on 4 February 2011.
  20. ^ Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Leers JM, Oezcelik A, Banki F, Lipham JC, DeMeester TR, Crookes PF (August 2009). “Obesity and Gastroesophageal Reflux: Quantifying the Association Between Body Mass Index, Esophageal Acid Exposure, and Lower Esophageal Sphincter Status in a Large Series of Patients with Reflux Symptoms”. J. Gastrointest. Surg. 13 (8): 1440–7. doi:10.1007/s11605-009-0930-7.
  21. ^ Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R (2004). “Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?”. Clin. Gastroenterol. Hepatol. 2 (9): 761–8. doi:10.1016/S1542-3565(04)00347-7.
  22. ^ Kasasbeh A, Kasasbeh E, Krishnaswamy G (2007). “Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex—a hypothetical review”. Sleep Med Rev. 11 (1): 47–58. doi:10.1016/j.smrv.2006.05.001.
  23. ^ O’Connor HJ (Feb 1999). “Helicobacter pylori and gastro-oesophageal reflux disease-clinical implications and management”. Aliment Pharmacol Ther. 13 (2): 117–27. doi:10.1046/j.1365-2036.1999.00460.x.
  24. ^ El-Omar EM, Oien K, El-Nujumi A, Gillen D, Wirz A, Dahill S, Williams C, Ardill JE, McColl KE (1997). “Helicobacter pylori infection and chronic gastric acid hyposecretion”. Gastroenterology. 113 (1): 15–24. doi:10.1016/S0016-5085(97)70075-1.
  25. ^ Fallone CA, Barkun AN, Mayrand S, Wakil G, Friedman G, Szilagyi A, Wheeler C, Ross D (2004). “There is no difference in the disease severity of gastro-oesophageal reflux disease between patients infected and not infected with Helicobacter pylori”. Aliment Pharmacol Ther. 20 (7): 761–8. doi:10.1111/j.1365-2036.2004.02171.x.

 

Happiness Medicine & Holistic Medicine Posts

Categories

Translate:

Translate »
error: Content is protected !!