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What You Need to Know About Reflux Disease
Most people report it as heartburn or tightness in the stomach, in medical slang is called GERD (Gastroesophageal reflux Disease). GERD is a common chronic and recurrent illness that affects millions of people all over the world. It is characterized by the flow of stomach acids upward, ie to the esophagus due to improper functioning or frequent opening of the esophageal sphincter/"valve" ( a ring-shaped muscle at the entrance of the stomach).
What is the cause of GERD?
In GERD, there is almost always a diaphragmatic hernia DH (when the upper part of the stomach and the esophageal sphincter pass over the diaphragm - the muscle separating your stomach from your chest).
The main cause of DH is the relaxation of the esophagus-supporting ligaments and the presence of weak points that support and fastening the esophagus to the diaphragm and the surrounding tissues.
Additional factors contributing to the appearance of DH and GERD are local fat accumulation due to obesity, as well as increased intra-abdominal pressure due to pregnancy, ascites, weight gain, and etc.
Also eating large meals, going to bed immediately after a meal, eating some foods such as citrus, tomato, chocolate, peppermint, garlic, onions, nuts or spicy and fatty foods, drinking beverages like alcohol, spirits, coffee, tea, and in some cases intake of certain medications may be the cause of GERD-symptoms. In the case of secondary refleux, we often have an absence of a DH. The reflux in this case depends on disorders of the stomach mobility.
What are the symptoms?
Most people with GERD have few symptoms or no discomfort due to DH. The classic symptoms are burning/heartburn, reflux/regurgitation, retrosternal chest pain, bloating, persistent hiccups, belching, nausea, wheezing, dry cough, hoarseness, or chronic sore throat. Sometimes coexists dysphagia, black stools, bloody vomiting, as a result of advanced esophagitis (GERD complication), weight loss without any obvious reason.
Another complication of GERD is also the Barrett's esophagus ( In Barrett's esophagus, normal tissue lining the esophagus -- the tube that carries food from the mouth to the stomach -- changes to tissue that resembles the lining of the intestine). The particular importance of Barrett's esophagus is that it has an increased risk of developing esophageal cancer.
Other common conditions that can mimic the symptoms of GERD include disturbances in esophageal motility and esophagus candidiasis (fungal infection).
Diagnosis of GERD is based on symptomatology. The most common test for people with GI symptoms is gastroscopy, where you can diagnose GERD, complications of GERD, and other conditions that can cause GERD. If gastroscopy does not confirm the presence of DH and/or patients who do not respond to the usual treatment, other specific examinations may be necessary, such as measurement of gastric acidity (esophageal pH) and study of esophageal motility (manometry).
What is the treatment?
In addition to simple countermeasures (avoiding large amounts of food and taking smaller and more frequent meals, avoiding food or drinks that favors reflux, avoiding going to sleep for at least 2-3 hours after eating, lifting the top of the bed or adding more pillows underneath head, avoiding smoking, weight loss for overweight patients, avoiding tight clothing or tightly tied belts, exercise), an important role in dealing with GERD have drugs that reduce acid production from the stomach. Depending on the patient's case, treatment of GERD may vary from simple measures to reduce reflux, occasional intake of medication, or daily intake of various medication.
Treatment of GERD is considered successful when it relieves the patient completely of the symptoms, improves the patients quality of life and heals esophagitis.
In cases of persistent GERD despite treatment, surgery can be an alternative.
Dr Demetrios Demetriou,
Geriatrics • Gerontology • Gastrenterology • Hepatology & Endoscopy
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