Heartburn and Reflux

Medical term for heartburn and reflux is called GERD-Gastroesophageal reflux disease. It is a medical condition produced by acid juice in your stomach flushing back into your esophagus, which irritates the lining of your esophagus and causes GERD symptoms. Typical GERD symptoms include heartburn, acid regurgitation, and sour taste in the mouth. These symptoms tend to happen after eating and lying down. There are also atypical symptoms and signs associated with GERD, such as:

-Trouble swallowing

-Hoarseness

-Sore throat

-Painful swallowing

-Chest pain

-Cough

-Asthma

Causes and risk factors:

  • Problem of Esophageal Sphincter. There is a gate at the end of the esophagus called lower esophageal sphincter (LES), which opens when food or saliva come down and otherwise remains closed. If LES does not close well or relaxes inappropriately, acid contains in the stomach will spill into the esophagus when the stomach contracts.
  • Hiatal hernia. A condition that is caused by a part of the stomach that moves above the diaphragm, which affects your LES closing. see picture at upper right.
  • Gastroparesis. This is a condition that slows down emptying of your gastric contains.
  • Scleroderma. A connective tissue disease that can weaken your lower esophageal sphincter, causing acid reflux.
  • Zollinger-Ellison syndrome. A condition that produces too much gastric acid.
  • Medications. Such as Aspirin, NSAIDS, etc.
  • Certain foods. Such as coffee, fatty fried food, chocolate, and spicy food, can make GERD worse.
  • Smoking.
  • Obesity.
  • Diabetes.
  • Pregnancy.

Complications of GERD:

GERD not only produces symptoms that affect you life, but also can damage the esophagus. Most common complications of GERD are:

  • Erosive esophagitis. It happens if the esophagus is exposed to too much of gastric acid and/or over a long period of time without treatment. In erosive esophagitis, patient may have trouble swallowing, bleeding, and anemia, etc. see lower right image.
  • Esophageal ulcer. Ulcer can form in the esophagus in GERD patients. It may cause painful swallowing, bleeding, and anemia, etc.
  • Stricture in the esophagus. Long term of GERD can damage the esophagus and cause scar tissue formation, which may cause trouble swallowing.
  • Barrett’s Esophagus.

Diagnosis and Treatment of GERD

Diagnosis of mostly is based on symptoms and may involve one or more of the following tests:

  • X-RAY
  • EGD
  • 24-hour Ph study
  • Manometry

Treatment options are:

  • Life style modifications
  • Medications, such as anti-acids, H2 blockers, PPI, prokinects, etc.
  • Surgery

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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