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PostPosted: 26 May 2019 22:30 
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Joined: 19 Dec 2017 14:21
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OVERVIEW
Gastroesophageal reflux disease (GERD) is said to occur when acid from stomach flows back into the food pipe (esophagus) that connects the oral cavity and the stomach. This acid reflux can irritate the lining of the esophagus causing burning sensation in the chest (heartburn).

Many people may experience acid reflux occasionally. Heartburn that occurs more than twice a week can be considered GERD, and if not treated can result in more serious complications.

In most cases, symptoms of GERD can be managed with lifestyle changes and over-the-counter medications. However, some patients may need stronger medications or even surgery to alleviate GERD symptoms.

CAUSES & RISK FACTORS OF GERD
Normally, when we swallow, a circular band of muscle encircling the lower end of the esophagus (lower esophageal sphincter) relaxes to allow food and liquid to enter the stomach. Once the food has entered the stomach, the sphincter closes to prevent back flow of stomach contents.

When the sphincter becomes weak or relaxes abnormally, stomach acid regurgitates up into the esophagus. The constant acid reflux irritates the lining of the esophagus, causing it to become red, inflamed and painful.

RISK FACTORS OF GERD
• Obesity
• Pregnancy
• Bulging of the upper part of the stomach through the diaphragmatic opening (hiatus hernia)
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying and acid content remains in stomach for a prolonged period

Factors that can aggravate existing GERD include
• Smoking
• Consuming large meals or eating late at night
• Increased consumption of fatty or fried foods
• Excess alcohol or coffee intake
• Medications, such as aspirin

SYMPTOMS OF GERD

Common signs and symptoms of GERD include the following
• Burning sensation in chest (heartburn), especially after a meal eating, and often worse at night
• Difficulty swallowing
• Chest pain
• Sensation of sour liquid or food in the food pipe
• Sensation of a lump in the throat

When GERD occurs at night, there may be associated symptoms such as
• Persistent cough
• Sore throat and change in voice
• Disrupted sleep
• Aggravation of pre-existing asthma or new onset asthma

COMPLICATIONS OF GERD
Chronic irritation of the esophageal lining can lead to the following complications
• Narrowing of the esophagus (esophageal stricture) – Chronic irritation of the lower esophagus from stomach acid causes scarring of the esophageal lining. The scar tissue narrows the food pipe and causes difficulty in swallowing (dysphagia)

• An open sore in the esophagus (esophageal ulcer) - Stomach acid can eat away the lining of the esophageal lining causing a break in the lining resulting in an ulcer that may cause pain, bleeding and difficulty in swallowing

• Precancerous changes to the esophagus (Barrett's esophagus) – Injury to the lower part of the esophagus by acid causes changes in the lining of the lower esophagus. These changes referred to as Barrett’s esophagus are precancerous and increase the risk of developing esophageal cancer

DIAGNOSIS OF GERD
Diagnosis of GERD can be suspected based on the history (see above) and physical examination findings. The diagnosis or the presence of complications can be confirmed by the following investigations

Upper GI endoscopy – A thin flexible tube with a light and camera (endoscope) is passed down the throat, to visualize the inside of the esophagus and stomach. Endoscopy may reveal esophageal inflammation with redness and swelling or the presence of scar tissue and narrowing of the lower part of the esophagus. During endoscopy, a sample of tissue (biopsy) can be taken for histopathological (microscopic) examination to rule out Barrett’s esophagus or early cancer

Esophageal pH measurement – If the diagnosis is unclear, the pH of the lower end of the esophagus can be measured

Esophageal manometry – This test is done to measure the force generated when the esophageal muscles contract and can detect weakness of the lower esophageal sphincter

Barium swallow – An x-ray of the chest and upper GIT is taken after the patient is made to drink a liquid containing barium that coats the lining of the esophagus and can demonstrate narrowing or stricture of the esophagus

Other tests – Tests such as chest x-ray and ECG may be done to rule out other conditions if symptoms are not typical

TREATMENT OF GERD
MEDICAL TREATMENT
Antacids – These are alkaline tablets or liquids that neutralize stomach acid. They are usually advised for mild or infrequent episodes of heartburn

Acid suppressing medications
– For more severe heartburn, drugs that suppress acid may be advised. The two classes of acid suppressants include proton pump inhibitors (PPIs) and histamine receptor blockers (H2 receptor blockers). PPIs are more effective in controlling symptoms and may be prescribed for a short duration but some patients may require longterm PPI therapy

Baclofen may be prescribed to strengthen the lower esophageal sphincter and reduce abnormal relaxation

Prokinetics
such as metoclopramide may be given to hasten the passage of food from the stomach, particularly if bloating and belching symptoms are predominant

SURGERY

Fundoplication - The top of the stomach is wrapped around the lower esophageal sphincter, to tighten the muscle and reduce acid reflux.

LINX device - A ring of tiny magnetic beads is wrapped around the junction of the lower esophagus and stomach. The magnetic attraction between the beads helps to keep the lower esophageal sphincter closed to prevent reflux of acid but allows passage of food. The device can be placed via minimally invasive surgery

[b]MEASURES TO REDUCE GERD SYMPTOMS

• Eat small but frequent meals
• Maintain a healthy weight
• Stop smoking
• Avoid fatty foods as they take longer time to leave the stomach
• Eat your supper well before bedtime
• Sit upright for at least an hour after meals
• Avoid tight clothing that press the abdominal area
• Keep the head about 8 inches above the bed using wooden blocks
• Avoid foods that trigger symptoms eg high fat milk, cheese, milk shakes, fried foods, chocolates, coffee, tea, alcohol and baked items


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