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GERD: Gastro-Esophageal Reflux Disease

Updated on April 3, 2012

Overview

GERD or acid reflux is a medical condition in which the acids of the stomach, and sometimes bile, flow back into the esophagus, the food pipe that connects the mouth cavity to the stomach, causing irritation to its lining cells. And, this irritation causes the familiar symptoms and signs of GERD; including acid reflux and heartburn.


View Slideshow: GERD: Gastro-Esophageal Reflux Disease...
View Slideshow: GERD: Gastro-Esophageal Reflux Disease...
Heart burn is the commonest symptom of GERD.
Heart burn is the commonest symptom of GERD.

Symptoms

The common symptoms accompanying GERD include:

  1. Heartburn: It is a burning sensation in your chest. Sometimes, it extends to your throat, you may feel a sour taste in your mouth.
  2. Difficulty inswallowing or Dysphagia.
  3. Chest pain: It may interfere with the chest pain of angina. The latter usually extends to your left shoulder and arm. Be cautious, if you have a heart problem.
  4. Dry cough.
  5. Sore throat and hoarseness of voice.
  6. Lump sensation in your throat.


Causes

In general, GERD is cause by repeated acid, and sometimes bile, reflux from your stomach into the esophagus causing its irritation. If this reflux is constant for long period of time, the esophagus becomes inflamed. And, if it isn’t appropriately treated, the condition may complicate and the esophagus becomes eroded causing bleeding and other chest manifestations.

Acid refluxes back into the esophagus when the lower esophageal sphincter (LES) doesn’t work properly. Normally, when the food is swallowed, LES opens to allow the food to enter into the stomach, and then it closes firmly. In GERD, the sphincter doesn’t close firmly; so it allows acids to flow back.


How is GERD  Developed?
How is GERD Developed?

Risk Factors

There are many factors that increase the susceptibility of GERD occurrence. These factors include:

  1. Diabetes and obesity.
  2. Pregnancy.
  3. Delayed Gastric Emptying: This makes food presents in stomach longer. And, hence acid becomes in contact with esophagus longer in patients with weak LES.
  4. Zollinger-Ellison Syndrome: It is characterized by presence of tumors secreting large amount of Gastrin hormone, which in turn increases the secretion of acid.
  5. Smoking, dry mouth and asthma.
  6. Hiatus Hernia: It is the protrusion of the abdominal viscera through the diaphragm into the chest applying pressure on the stomach.


Complication

If GERD is left untreated for long period of time, the condition may complicate. These complications include:

Complications of GERD:

Click thumbnail to view full-size
#1: Esophageal stricture which is a narrowing of the lower end of the esophagus.Another illustration of Esophageal stricture.#2: Esophageal ulcers due to repeated irritation of the esophagus by gastric acid.#3: Barrett's Esophagus which is a precancerous change in the structure of the lining of your esophagus.The type of cells lining the esophagus, naturally are columnar epithelium, becomes squamous epithelium, a condition called Barrett's Esophagus.
#1: Esophageal stricture which is a narrowing of the lower end of the esophagus.
#1: Esophageal stricture which is a narrowing of the lower end of the esophagus.
Another illustration of Esophageal stricture.
Another illustration of Esophageal stricture.
#2: Esophageal ulcers due to repeated irritation of the esophagus by gastric acid.
#2: Esophageal ulcers due to repeated irritation of the esophagus by gastric acid.
#3: Barrett's Esophagus which is a precancerous change in the structure of the lining of your esophagus.
#3: Barrett's Esophagus which is a precancerous change in the structure of the lining of your esophagus.
The type of cells lining the esophagus, naturally are columnar epithelium, becomes squamous epithelium, a condition called Barrett's Esophagus.
The type of cells lining the esophagus, naturally are columnar epithelium, becomes squamous epithelium, a condition called Barrett's Esophagus.
  • Esophageal Stricture: It is narrowing of the esophagus due to persistent irritation of the lower end of the esophagus. This continuous irritation leads to the formation of scar tissue narrowing the esophageal lumen. Then, there will be difficulty in swallowing.
  • Esophageal Ulcer: The continuous exposure of the lower end of the esophagus to acid erodes the esophageal lining and cause ulcer to form. The ulcer may bleed or cause pain during swallowing.
  • Barrett’s Esophagus: It is a precancerous change in the color and structure of the tissue lining the lower part of the esophagus. This change is associated with increased risk of cancer; however, the risk of cancer development is low.

Diagnosis

Your doctor may diagnose GERD only from your medical history of repeated heartburns and other symptoms associated. Other investigations can confirm this diagnosis, which include:

Your medical history and your symptoms may be enough to be diagnosed as GERD...
Your medical history and your symptoms may be enough to be diagnosed as GERD...
  1. X-Ray: A special type of x-ray, and called Barium Swallow is used in diagnosing GERD. It includes swallowing of chalky fluid that coats the lining of your esophagus. Then, an X-ray image of your upper digestive system is taken. If there is any filling defect of your esophagus, it will be visible in the image.
  2. Endoscopy: Endoscopy is a flexible tube with a camera and light fixed at its tip. Your doctor will insert it into your throat, with the help of specific gel, to visualize the interior of your esophagus and stomach. In certain cases, he/she may also collect tissue samples (biopsies) from your esophagus and stomach to be used for further investigations.
  3. Endoscopy is the key test in diagnosing Barrett’s esophagus, one of the most common GERD complications.
  4. Ambulatory acid (pH) probe test: This test uses special acid-measuring device to identify the duration of esophagus exposure to stomach acids. During this procedure, a probe is introduced into your esophagus by a catheter, which is a thin flexible tube entered through your nose down your esophagus, or a clip fixed into the esophagus during endoscopy. This probe will detect the acids present in the esophagus for two days, and transmit signals to a small computer fixed around your waist or shoulder. The data collected by the probe gives your doctor an idea about the esophageal exposure to acids. Eventually, the probe falls and passes with stool.
  5. Testing of the movements of the esophagus: This test uses a probe introduced into your esophagus through your nose. This probe measures the pressure and movement of your esophagus.


GERD Treatments:

Medical, Surgical and Natural Treatments

Usually, mild cases of GERD responds to over-the-counter drugs that control stomach acids, and relieve the associated signs and symptoms especially, the heartburn. However, relief may not be achieved with a few weeks. In this case, your doctor may prescribe more powerful medications or even surgery.


Medical Treatments

  • Over-the-counter Medications

They are the initial line of treatment of GERD. These medications don’t need to be prescribed by a doctor as they are usually used to control acid. They include:

  1. Antacids: They are medications used to neutralize stomach acid, and cause rapid relief. Antacids include Maalox, Gelusil, Mylanta and others. They must be used in combination with other drugs; as antacids can’t alone heal inflamed esophagus by gastric acid. Some antacids may cause diarrhea or constipation as a side effect.
  2. H2 Blockers: Although they can provoke relief as rapidly as antacids, they act for longer period. H2 Blockers decrease the production of acid by the stomach, and they include Famotidine (Pepcid AC), Cimetidine (Tagamet HB), Nizatidine (Axid AR) and Ranitidine (Zantac 25, 75,150)
  3. Proton Pump Inhibitors: Besides reducing acid production, they promote healing of the inflamed esophagus. They include Lansoprazole (Prevacid 24 HR) and Omeprazole (Prilosec OTC).

Click thumbnail to view full-size
OTC medications such as antacids and those lowering the gastric acidity are the first choice in treating mild cases of GERD.Antacids form a protective layer over your gastric contents preventing them from flowing back into the esophagus.Prilosec is one of proton pump inhibitors, available in both OTC and prescriptive forms.Zantac is one of H2 blockers which decrease your production of stomach acids. And, it is also available in both OTC and Prescriptive forms.
OTC medications such as antacids and those lowering the gastric acidity are the first choice in treating mild cases of GERD.
OTC medications such as antacids and those lowering the gastric acidity are the first choice in treating mild cases of GERD.
Antacids form a protective layer over your gastric contents preventing them from flowing back into the esophagus.
Antacids form a protective layer over your gastric contents preventing them from flowing back into the esophagus.
Prilosec is one of proton pump inhibitors, available in both OTC and prescriptive forms.
Prilosec is one of proton pump inhibitors, available in both OTC and prescriptive forms.
Zantac is one of H2 blockers which decrease your production of stomach acids. And, it is also available in both OTC and Prescriptive forms.
Zantac is one of H2 blockers which decrease your production of stomach acids. And, it is also available in both OTC and Prescriptive forms.
  • Prescription Medications

These medications are stronger that over-the-counter medications. Your doctor may recommend them, if your symptoms haven’t relieved with the initial treatment. They include:

  1. Prescription H2 Blockers: They include prescription strength Famotidine (Pepcid), Cimetidine (Tagamet), Nizatidine (Axid) and Ranitidine (Zantac).
  2. Prescription Proton Pump Inhibitors: They include Lansoprazole (Prevacid), Esomeprazole (Nexium), Pantoprazole (Protonix), Rabeprazole (Aciphex) and Omeprazole (Prilosec). Sometimes, these drugs increase the risk of bone fractures and lead to bone loss. Calcium supplements may correct this problem. Blood thinning drugs such as Clopidogrel (Plavix) may become less effective when taken with them.
  3. Medications to increase lower esophageal pressure: These drugs make your stomach empty more rapidly, and increase the contraction of LES (lower EsophagealSphincter). Some adverse effects may be associated with these medications such as fatigue, anxiety and depression.


Surgical Treatment

If the previous lines of treatment fail to control GERD, your doctor may indicate surgery. There are several types of surgeries. They include:

Click thumbnail to view full-size
#1: Nissen fundoplication.Another illustration of Fundoplication.#2: EndoClinch Endoluminal Gastroplication.#3: Stretta Procedure which is hating the esophageal tissue to make it fibrose.
#1: Nissen fundoplication.
#1: Nissen fundoplication.
Another illustration of Fundoplication.
Another illustration of Fundoplication.
#2: EndoClinch Endoluminal Gastroplication.
#2: EndoClinch Endoluminal Gastroplication.
#3: Stretta Procedure which is hating the esophageal tissue to make it fibrose.
#3: Stretta Procedure which is hating the esophageal tissue to make it fibrose.
  1. Nissen Fundoplication Surgery: It reinforces the lower esophageal sphincter by wrapping the uppermost part of the stomach around the outside of the lower part of the esophagus. It may be an open surgery, in which large incision is made in the abdomen, or a laparoscopic surgery, where 3 or 4 small incision are made for the laparoscope to be inserted.
  2. EndoCinch Endoluminal Gastroplication: It prevents the back flow of acid into the esophagus by creating a barrier from the part of the stomach near the esophagus. A small tool like sewing machine makes pairs of stitches in the stomach. Then, the suturing material of the stitches is tied together to form the barrier that will prevent the acid from flowing back into the esophagus.
  3. Stretta Procedure: It aims to form a scar tissue in the esophagus by heating the esophageal tissue. And, it also damages the nerves present in this area. In this procedure, your doctor uses electrode energy to heat the tissue.


Natural Treatments of GERD

There is no natural treatment able to reverse the damage occurred to the esophagus. However, there are some natural remedies that may relief the associated symptoms. These natural remedies include:

Natural remedies for GERD Treatment:

Click thumbnail to view full-size
#1: Herbal remedies such as chamomile may be used in the treatment of GERD.#2: Relaxation Therapies help decrease stress and subsequently Acid production.#3: Acupuncture may relieve heartburn.
#1: Herbal remedies such as chamomile may be used in the treatment of GERD.
#1: Herbal remedies such as chamomile may be used in the treatment of GERD.
#2: Relaxation Therapies help decrease stress and subsequently Acid production.
#2: Relaxation Therapies help decrease stress and subsequently Acid production.
#3: Acupuncture may relieve heartburn.
#3: Acupuncture may relieve heartburn.
  1. Herbal Remedies: Herbal remedies, such as licorice, chamomile and marshmallow. Herbal remedies may have serious side effects or interfere with the medications you take.
  2. Relaxation Therapies: They are techniques used to decrease stress and relieve anxiety. They include progressive muscle relaxation and guided imagery.
  3. Acupuncture: It means the use of needles inserted into certain points into your body to relieve heartburn.


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