Gastroesophageal reflux disease (GERD) is a common relapsing gastrointestinal disorder that many people manage without a doctor's advice until it becomes chronic, according to the National Digestive Diseases Information Clearinghouse (NDDIC). It is caused by gastroesophageal reflux, a condition in which the stomach contents enter the esophagus through a malfunctioning lower esophageal sphincter (LES).
Description
The lower esophageal sphincter functions as a physical barrier against the gastric contents from the stomach. What distinguishes GERD from regular acid regurgitation/reflux is the esophageal acid load which must be great enough to cause damage to the esophageal mucosa and pain. Symptoms must occur more than twice a week. Heartburn, also known as acid indigestion, is one of the main signs of GERD in adults, who typically complain of a burning pain in the chest and mid-abdomen. It is a treatable disease that involves medications such as antacids, lifestyle changes or surgery. Complications of GERD include an inflamed esophagus, strictures, ulcerations and Barrett's esophagus, which causes cellular changes.
Symptoms
The classical clinical symptoms of GERD are heartburn and regurgitation, although in children these might not be common. Other symptoms such as a dry cough, asthma symptoms or trouble swallowing might indicate GERD in children or adults. Diagnostic tests can be used for a more definite diagnosis when the classic symptoms are absent. Chest pain in GERD, known as heartburn, is recurrent, intermittent and can mimic angina pectoris. It is a burning pain behind the breastbone, that starts in the upper abdomen and radiates to the back, neck and jaw. Sometimes the severity of the pain can be intense, requiring medications to relieve the symptoms. It can occur after eating, or while bending over, or at night while lying down. When the pain radiates to the back, one can mistake it for regular back pain. The reflux of acid into the esophagus can sometimes give the feeling of a lump in the throat. Most patients will describe that feeling as a heavy, hot liquid stuck on the lining of the throat. This irritation can lead to a painful form of sore throat, with a burning sensation felt especially while talking or swallowing.
Medications
The initial mode of treatment for GERD is through the use of medications and lifestyle changes; when this does not help, surgery might be a better alternative. Lifestyle modifications include a reduced-fat diet, smoking cessation, reduced alcohol consumption and avoiding certain foods such as caffeine, chocolate, spicy foods, citrus juices and tomato-based products.
Medications such as antacids and alginic acid provide quick relief of symptoms. They rapidly increase the pH of the gastric refluxate. Over-the-counter histamine H2 receptor blockers help with the prevention and relief of heartburn and acid indigestion. They have a slower onset compared to antacids but have a longer impact. H-2 receptor blockers are used for treating reflux symptoms and esophagitis. Prokinetic agents increase both emptying and lower esophageal sphincter pressure. Proton pump inhibitors diminish gastric acid secretion in the stomach.
Surgery
Surgery provides long-term relief for patients who find medical therapy inadequate or develop complications. According to the University of Maryland General/Gastrointestinal Surgery Center, a surgical procedure known as open Nissen fundoplication surgery is a highly effective treatment for GERD sufferers. In this method, the upper part of the stomach is wrapped around the lower esophageal sphincter which helps in preventing acid reflux and in repairing a hiatal hernia. The surgery is done either through the abdomen or stomach. The procedure can be performed using a laparascopic method or via a larger incision, known as open surgery. Recovery for the former is quicker with the patient usually recovering in 2 to 3 weeks, while open surgery can take 4 to 6 weeks. There are risks involved with this surgery such as difficulty swallowing, heartburn, bloating and excess gas, in addition to the usual risks posed by anesthesia, infection or bleeding.
