What Are the Basics of Gastroesophageal Reflux Disease?

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imageOverview

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents pass back up into the esophagus (food pipe). This backwash (acid reflux) can irritate the lining of your esophagus and cause other symptoms (see pictures right).

Signs and symptoms

Common symptoms of GERD include:
  • Feeling that food is stuck behind the breastbone
  • Heartburn or a burning pain in the chest
  • Nausea after eating
Less common symptoms are:
  • Bringing food back up (regurgitation)
  • Cough or wheezing
  • Difficulty swallowing
  • Hiccups
  • Hoarseness or change in voice
  • Sore throat
Symptoms may get worse when you lie down or after you eat.

Causes

A ring of muscle fibers between the lower esophagus and stomach is called the lower esophageal sphincter (LES). When food passes down into the stomach, the LES prevents swallowed food from moving backwards. However, if the LES does not work properly, the stomach contents can leak back into the esophagus. This procedure is acid reflux or gastroesophageal reflux. And if the reflux happens frequently and lasts for a long time, it develops into GERD.

Risk factors

The risk factors of reflux may include:
  • Obesity
  • Smoking
  • Pregnancy
  • Scleroderma
  • Dreaking alcohol (possibly)
  • Reclining within 3 hours after eating
  • Hiatal hernia (the upper part of your stomach bulges through diaphragm, the muscle separating your abdomen and chest.)
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Diagnosis

If your symptoms are severe, your doctor might recommend:
  • Upper endoscopy. During the test, your doctor passes a thin, flexible tube equipped with a light and camera (endoscope) down your throat. This is to examine the inside of your esophagus and stomach. In addition, the doctor will collect a sample of tissue (biopsy) for testing complications.
  • Esophageal manometry. This is a test to measure the pressure inside the lower part of the esophagus
  • Ambulatory acid (pH) probe test. This test measures how often stomach acid enters the esophagus.
  • X-ray of your upper digestive system. Before the X-rays, you will drink a chalky liquid containing barium. This will allow your doctor to see the shape of your esophagus, stomach and upper intestine.

Treatment

Your doctor may recommend changing your lifestyle and taking the over-the-counter medications first. If they do not work, the doctor might recommend prescription medication or surgery.
Lifestyle and home remedies
  • Stop smoking.
  • Maintain a healthy weight.
  • Avoid tight-fitting clothing.
  • Don't lie down after a meal.
  • Eat food slowly and chew thoroughly.
  • Elevate the head of your bed to reduce heartburn during sleeping.
  • Avoid foods and drinks that trigger reflux. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
Over-the-counter medications
  • Antacids that neutralize stomach acid.
  • H-2-receptor blockers to reduce acid production.
  • Proton pump inhibitors that block acid production and heal the esophagus.
Prescription medications
  • Prescription-strength H-2-receptor blockers, such as famotidine (Pepcid), nizatidine and ranitidine (Zantac).
  • Prescription-strength proton pump inhibitors, including esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
  • Medication to strengthen the lower esophageal sphincter, such as baclofen.
Surgery
If the symptoms do not improve with lifestyle changes or medicines, you may need an anti-reflux surgery. Your doctor might recommend a minimally invasive surgery called fundoplication to prevent reflux. The symptoms should improve after the surgery, but you may still need to take medicines for your heartburn. Keywords: gastroesophageal reflux disease
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