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A systematic review published in the British medical journal estimated that the prevalence of GERD is highest in North America (19.8–20%) followed by Europe (9.8–18%) and lowest in Asia (2.5–4.8%).
Gastroesophageal reflux disease (GERD) is a chronic disease of the digestive system. It may be defined as the symptoms and/or signs of damage to the esophagus as a consequence of the reflux of the stomach’s contents24, 25. GERD occurs when the lower esophageal sphincter relaxes despite the presence of food in the stomach when it should be closed. This may happen as a result of multiple risk factors including a hiatal hernia, pregnancy, being overweight, or obese smoking, medications and stress. Some foods such as coffee, alcohol, tomatoes and citrus fruits may cause temporary relaxation of the lower esophageal sphincter.
Heartburn and acid reflux are the most common symptoms of GERD. Esophagitis (an irritated, reddened esophagus) also may occur. Mores serious symptoms include respiratory problems, a sore throat and a raspy, or strained voice, nausea and vomiting, particularly after meals. In most cases, gastroesophageal reflux (GER) is diagnosed by evaluating the patient’s symptoms and medical history. If the symptoms doesn’t respond to lifestyle changes and medications, the doctor may recommend additional tests such as an upper gastrointestinal (GI) endoscopy and biopsy, esophageal manometry and esophageal pH and impedance monitoring.
The first line of management is using conservative treatment and medication such as antacids and H2 blockers, in addition to lifestyle changes such as weight loss, reducing consumption of foods that may increase the symptoms such as coffee, tomatoes, citrus fruits and mint.
Patients that do not respond to medication and lifestyle may need surgical intervention, of which the most commonly used method is the Nissen 360° fundoplication procedure. Left untreated, GERD may cause serious complications including esophageal bleeding or ulcers, esophagitis (inflammation of the esophagus), Barrett’s esophagus (precancerous changes in the esophagus), esophageal strictures (narrowing of the esophagus) and respiratory complications (asthma, pneumonia).
Lifestyle changes may helpful to prevent or relieve symptoms of GERD. These include eating small, frequent meals instead of a large meal three times daily, wait at least three hours after food before lying down and avoiding certain foods that may aggravate the symptoms of GERD such as coffee, greasy or spicy foods, tomatoes and alcohol. The prognosis for GERD is generally very good. It is a treatable disease and most people respond to medication and lifestyle changes. Some people, however, need to continue using medication to control their symptoms.
A systematic review published in the British medical journal estimated that the prevalence of GERD is highest in North America (19.8–20%) followed by Europe (9.8–18%) and lowest in Asia (2.5–4.8%).
Gastroesophageal reflux (GER) occurs when the contents of the stomach return into the esophagus, causing heartburn. Having GER occasionally is common. GER that happens more than twice a week frequently (for a few weeks) could be Gastroesophageal reflux disease (GERD). GERD may cause more serious health problems over time.
Gastroesophageal reflux disease (GERD) is a chronic disease of the digestive system. It occurs when the quantity of gastric content refluxing back into the esophagus exceeds the normal limit, causing symptoms and tissue damage. This happens because the lower esophageal sphincter relaxes (opens) when it is supposed to be closed.
The lower esophageal sphincter, a circular band of muscle around the lower part of the esophagus, normally relaxes to let food into the stomach and then it closes again.
GERD occurs when the lower esophageal sphincter relaxes when it shouldn’t. This may happen as a result of multiple risk factors.
Multiple risk factors may cause the lower esophageal sphincter to relax, including:
Temporary relaxation of the lower esophageal sphincter can be caused by foods such as coffee, alcohol, citrus fruits, spicy foods, chocolate, fatty or oily meals, tomato sauce, mint, garlic and onion.
The lower esophageal sphincter normally relaxes during swallowing to allow food to empty into the stomach, and then closes after that preventing stomach content from moving back into the esophagus. Failure of the sphincter to contract (close) will lead to a reflux of gastric content into the esophagus and the development of gastroesophageal reflux disease that with time may lead to esophagitis (inflammation or irritation of the esophagus), metaplasia or Barrett's esophagus (tissue in the esophagus is replaced by tissue similar to the intestinal lining7) and cancer.
Signs and Symptoms of gastroesophageal reflux disease
Heartburn is the most common symptom of GERD. Heartburn is a painful, burning sensation in the chest, usually just below the breastbone. The feeling may spread up to the throat. The pain is typically worse after a meal, when lying down or bending over.
Acid reflux is another typical symptom of GERD. Acid and other stomach contents are regurgitated (brought back up) into the throat and mouth, resulting in a bad, sour taste at the back of the mouth.
Other symptoms of GERD include:
Abnormal reflux may produce atypical (extraesophageal) symptoms, such as the following:
Some symptoms of GERD are a result of its complications, such as those affecting the lungs.
In most cases, gastroesophageal reflux (GER) is diagnosed by evaluating the patient’s symptoms and medical history. If the symptoms doesn’t respond to lifestyle changes and medications, it may be an indication of GERD and the doctor recommends additional tests.
If the patient presents with atypical symptoms, it may be an indication of GERD patient history is noted and additional tests are recommended.
Upper gastrointestinal (GI) endoscopy and biopsy
This test allows the physician to evaluate the presence and severity of the complications of GERD 13. A biopsy may be taken during the endoscopy and analyzed. Pathologic analysis of the biopsy confirms the diagnosis of GERD.
Esophageal manometry
Esophageal manometry measures esophageal muscle contractions. It is used to assess the function of the lower esophageal sphincter and enables the doctor to diagnose other problems that may result in symptoms similar to heartburn. Esophageal manometry is essential for correctly positioning the probe for the 24-hour pH monitoring.
Esophageal pH and impedance monitoring (24-Hour pH Monitoring)
It is the most accurate procedure to detect acid reflux. It measures the amount of acid in the esophagus while the patient performs normal activities, such as eating and sleeping. The test quantifies when and how much acid refluxes into the esophagus. The test is also helpful in determining whether respiratory symptoms such as wheezing and coughing are caused by the reflux.
Barium swallow/ Upper GI series/ upper GI X-ray
This test is unable to show GERD in the esophagus. It is used to detect the presence of any structural abnormalities in the esophagus, such as hiatal hernias, esophageal strictures and ulcers.
Bravo wireless esophageal pH monitoring
The test measures and records the pH in the esophagus. A small capsule is attached to the esophageal wall during an endoscopy. The capsule determines the pH levels in the esophagus and transmits the information to a receiver.
The receiver has buttons on it that the patient should press to record heartburn and other GERD symptoms. The patient is also asked to maintain a diary to record the beginning and end of a meal, when the patient lies down, and when the patient stands or sits up again.
Intraluminal Esophageal Electrical Impedance
Intraluminal esophageal electrical impedance, a more recent test, is helpful for identifying both acid and nonacid reflux through assessing retrograde flow in the esophagus.
Nuclear Medicine Gastric Emptying Study
Gastric-emptying studies are useful for patients when delayed gastric emptying is suspected to cause the symptoms of GERD. These tests are not commonly used in adult patients as a result of their limited sensitivity and the availability of better tests. However these tests are commonly used in infants and children due their noninvasive nature.
The first line of management is using conservative treatment and medication.
Medication:
Antacids
Antacids neutralize stomach acid. They are fast acting medication used to relieve heartburn and other mild GERD symptoms. Antacids alone do not heal an irritated esophagus damaged by stomach acid (esophagitis).
Foaming agents
These medicines act to prevent reflux by coating the contents of the stomach with foam. They may be helpful to patients with no esophageal damage 12.
H2 blockers
H2 blockers decrease acid production. They act slower than antacids, but provide longer relief. Their effect may last up to 12 hours. They may also help heal esophagitis.
Proton pump inhibitors (PPIs)
PPIs lower the quantity of acid produced by the stomach. They are better than H2 blockers at treating GERD symptoms. They are also able to heal the lining of the esophagus in most people. PPIs are often prescribed for long-term treatment of GERD.
Prokinetics
Prokinetics help helps strengthen the lower esophageal sphincter and assist the stomach in emptying quicker. They may cause problems if mixed with other medication.
Antibiotics
Such as macrolide antibiotics (erythromycin) help the stomach empty faster and have fewer side effects than prokinetics.
Surgery:
Chronic persistent GERD that doesn’t resolve with medication and lifestyle changes may need surgical intervention to relieve the symptoms.
Nissen 360° fundoplication procedure:
Fundoplication procedures are the most common surgical treatment method for GERD. This procedure tightens the lower esophageal sphincter by wrapping the uppermost part of the stomach around the sphincter. This procedure may also be used to repair a hiatal hernia.
Surgery to strengthen the lower esophageal sphincter (Linx)
The Linx device is a band of miniscule magnetic titanium beads. The device is wrapped around the Gastroesophageal junction. The magnetic attraction between the beads is able to prevent acid from refluxing while allowing food to pass through.
Endoscopic techniques, such as endoscopic sewing and radiofrequency:
In endoscopic sewing, small stitches are used to tighten the lower esophageal sphincter. Radiofrequency produces sores or heat lesions that help tighten the lower esophageal sphincter. The aforementioned techniques are not used often, as fundoplication produces better results.
Chronic complications of GERD include:
Esophageal bleeding or ulcers.
Esophagitis
Esophagitis is irritation or inflammation of the esophagus. People who suffer from chronic esophagitis have a higher risk of developing precancerous changes in the esophagus.
Barrett's esophagus
Tissue in the esophagus is replaced by tissue similar to the intestinal lining. People with Barrett’s esophagus have a higher risk of developing esophageal cancer.
Esophageal strictures
An esophageal stricture occurs when the esophagus becomes too narrow. Esophageal strictures may cause swallowing problems.
Respiratory problems
Such as:
Lifestyle changes may helpful to prevent or relieve symptoms of GERD.
Lifestyle changes:
GERD is a treatable disease, the majority of people respond to medication and lifestyle changes. However, some people need to continue using medication to control their symptoms.
A systematic review published in the British medical journal estimated that the prevalence of GERD is highest in North America (19.8–20%) followed by Europe (9.8–18%) and lowest in Asia (2.5–4.8%).
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