Gastroesophageal reflux disease, commonly referred to as GERD, is defined as the retrograde flow of stomach contents into the esophagus. It is a prevalent condition that often goes untreated. A study in the May-June issue of "The Journal of Gastrointestinal Surgery" reports that GERD is often caused by dysfunction of the lower esophageal sphincter, but contributing to the disorder in a significant number of people is abnormal peristalsis in the esophagus.
Abnormal Peristalsis Incidence
Peristalsis is the radial symmetrical contraction of smooth muscle that propels food down the esophagus to the stomach. An August 2010 review in the "World Journal of Gastroenterology" notes that peristalsis is abnormal in 40 to 50 percent of patients with GERD and is severely impaired in about 20 percent.
GERD Symptoms
In many cases, the symptoms of GERD are mild, but in some people, the symptoms, mainly heartburn, are severe, occur daily and significantly affect quality of life. The study in "The Journal of Gastrointestinal Surgery" reports that in people with abnormal peristalsis, the symptoms of GERD are more severe and injury to the tissue of the esophagus is more prevalent. This is because the peristaltic movement of the esophagus controls the amount of time the acidic stomach contents remain in contact with the esophageal tissue.
Esophageal Clearance
A common measurement taken in people with more severe symptoms of GERD is the average esophageal clearance time. This measurement is the total minutes that the acidity of the contents in the esophagus is below 4 divided by the number of reflux episodes. Patients with slow esophageal clearance time are more prone to severe tissue injury including Barrett's esophagus and other symptoms such as cough. Barrett's esophagus is a precancerous condition and approximately 13 percent of patients with chronic GERD develop this condition, according to a study in the February 2005 issue of "Gastrointestinal Endoscopy."
Treatment Options
The current drug treatments for GERD reduce the acidity of the stomach contents, but do not affect peristaltic movement in the esophagus. The only treatment that improves peristalsis is surgical and called fundoplication. The review in the "World Journal of Gastroenterology" notes that this procedure is minor and eliminates or controls symptoms in 93 percent of patients after 5 years. The procedure involves wrapping part of the upper stomach around the esophagus leading to an increase in closing of the esophageal sphincter and improved esophageal motility.
References
- Colorado State University: Hypertexts for Biomedical Sciences---Peristalsis
- "World Journal of Gastroenterology"; Gastroesophageal Reflux Disease: From Pathophysiology to Treatment; Fernando A Herbella and Marco G Patti; August 2010
- Gastrointestinal Endoscopy: The Frequency of Barrett's Esophagus in High-risk Patients with Chronic GERD
- PubMed.gov: Esophageal Dysmotility and Gastroesophageal Reflux Disease
- MayoClinic.com: GERD
