Reflux

Gastroesophageal reflux disease (GERD) is a condition due to back flow of stomach juice or sometime bile  into your esophagus (Food Pipe). This back flow irritate the lining of the esophagus and causes symptoms of GERD. Common sign and symptom of GERD are acid reflux and heartburn.

Though these symptom are quiet common but when these symptoms occur at least twice a week and interfere with your daily activities then it is termed as GERD.

GERD signs and symptoms include:
  • A burning sensation in your chest (heartburn), sometimes spreading to the throat, along with a sour taste in your mouth
  • Chest pain
  • Difficulty swallowing (dysphagia)
  • Dry cough
  • Hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Sensation of a lump in the throat

GERD is caused by frequent acid reflux — the backup of stomach acid or bile into the esophagus. When you swallow, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again. However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn and disrupting your daily life. This constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems.

Associated condition which will aggravate GERD are:
  • Obesity
  • Hiatal hernia
  • Pregnancy
  • Smoking
  • Dry mouth
  • Asthma
  • Diabetes
  • Delayed stomach emptying
  • Connective tissue disorders, such as scleroderma
  • Zollinger-Ellison syndrome.
Over time, chronic inflammation in your esophagus can lead to complications, including:
  • Narrowing of the esophagus (esophageal stricture). Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing difficulty swallowing.
  • Esophageal ulcer. Stomach acid can severely erode tissues in the esophagus, causing an ulcer to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.
  • Precancerous changes to the esophagus (Barrett’s esophagus). In Barrett’s esophagus, the color and composition of the tissue lining the lower esophagus change. These changes are associated with an increased risk of esophageal cancer. The risk of cancer is low, but your doctor will likely recommend regular endoscopy exams to look for early warning signs of esophageal cancer.

If you’re bothered by frequent heartburn or other signs and symptoms, your doctor may be able to diagnose GERD with that information alone. Your doctor may also suggest tests and procedures used to diagnose GERD, including:

  • Passing a flexible tube down your throat. Endoscopy is a way to visually examine the inside of your esophagus. During endoscopy, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. The endoscope allows your doctor to examine your esophagus and stomach. Your doctor may also use endoscopy to collect a sample of tissue (biopsy) for further testing. Endoscopy is useful in looking for complications of reflux, such as Barrett’s esophagus.
  • A test to monitor the amount of acid in your esophagus. Ambulatory acid (pH) probe tests use an acid-measuring device to identify when, and for how long, stomach acid regurgitates into your esophagus. The acid monitor can be a thin, flexible tube (catheter) that’s threaded through your nose into your esophagus. During the test, the tube stays in place and connects to a small computer that you wear around your waist or with a strap over your shoulder. Or the acid monitor can be a clip that’s placed in your esophagus during endoscopy. The probe transmits a signal to a small computer that you wear around your waist for about two days, and then the probe falls off to be passed in your stool. Your doctor may ask that you stop taking GERD medications to prepare for this test.
  • A test to measure the movement of the esophagus. Esophageal motility testing measures movement and pressure in the esophagus. The test involves placing a catheter through your nose and into your esophagus.
  • An X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract. The coating allows your doctor to see a silhouette of the shape and condition of your esophagus, stomach and upper intestine (duodenum).
Things you can do to reduce symptoms:

Lifestyle changes may help reduce the frequency of heartburn. Consider trying to:

  • Maintain a healthy weight. Excess weight put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. If your weight is healthy, work to maintain it. If you are overweight or obese, work to slowly lose weight — no more than 0.5 to 1 kilogram a week.
  • Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
  • Avoid foods and drinks that trigger heartburn. Everyone has specific triggers. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine may make heartburn worse. Avoid foods you know will trigger your heartburn.
  • Eat smaller meals. Avoid overeating by eating smaller meals.
  • Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
  • Elevate the head of your bed. If you regularly experience heartburn at night or while trying to sleep, put gravity to work for you. Place wood or cement blocks under the feet of your bed so that the head end is raised by six to nine inches. If it’s not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up.
Initial treatments to control heartburn

Over-the-counter treatments that may help control heartburn include:

  • Antacids that neutralize stomach acid. Antacids, Gelusil, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
  • Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine, famotidine), nizatidine or ranitidine. H-2-receptor blockers don’t act as quickly as antacids, but they provide longer relief. Stronger versions of these medications are available in prescription form.
  • Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include  omeprazole and pantoprazole etc.
  • Medications to strengthen the lower esophageal sphincter. Called prokinetic agents, these medications help your stomach empty more rapidly and help tighten the valve between the stomach and the esophagus. Side effects, such as fatigue, depression, anxiety and other neurological problems, limit the usefulness of these medications.
  • GERD medications are sometimes combined to increase effectiveness.
Surgery

If you require long term medicines to control your symptoms it is advised to undergo surgery. Surgery is preferred as long term medicine use has been linked to various complications.

Surgery is laparoscopic fundoplication. The surgeon makes three or four small incisions in the abdomen and inserts instruments, including a flexible tube with a tiny camera, through the incisions.This surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus.