Gastroesophageal Reflux Disorder (GERD) - Symptoms and Treatment

Gastroesophageal Reflux Disorder (GERD) - Symptoms and Treatment

Gastroesophageal Reflux Disorder (GERD) - a chronic condition in which gastric contents leak back from the STOMACH into the ESOPHAGUS. Because stomach juices are highly acidic, this backwash creates chemical BURNS in the delicate tissues of the esophagus. The lining of the esophagus lacks the protective mucus that safeguards the stomach from gastric acid, making it vulnerable to injury. Up to 40 percent of adults in the United States have GERD. Though GERD can develop in people of any age, including children, the likelihood of it doing so increases with age. Treatments to manage GERD include medical, surgical, and lifestyle methods.

Symptoms of Gastroesophageal Reflux Disorder (GERD) and Diagnostic Path

The symptoms of GERD often appear or are more severe following meals, when lying on the back, when bending over, and when lifting or straining. Many people experience more severe symptoms at night that awaken them from sleep. Typical GERD symptoms are chronic (ongoing) and include

  • PAIN, pressure, or burning sensation in the midchest
  • NAUSEA, and less commonly VOMITING, after eating
  • regurgitation (reflux) of stomach contents up to several hours after eating that causes a bitter taste in the MOUTH and a burning sensation in the THROAT
  • a sense of fullness in the stomach even when hungry

Some people also experience chronic sore throat or hoarseness resulting from the persistent reflux, or HICCUPS, likely due to irritation of the DIAPHRAGM, where the esophagus and stomach join, which is the site of the irritation. The diagnostic path may include BARIUM SWALLOW, gastroesophagoscopy (endoscopic examination of the esophagus and stomach), and breath or BLOOD tests for the presence of HELICOBACTER PYLORI. Because GERD is so common and the diagnostic procedures are invasive, doctors often use a trial of medication, such as H2 ANTAGONIST (BLOCKER) MEDICATIONS or PROTON PUMP INHIBITOR MEDICATIONS (PPIs), to suppress gastric acid production and then assume a diagnosis of GERD if the medication relieves the symptoms.

Gastroesophageal Reflux Disorder (GERD) Treatment and Outlook

Most people obtain full relief from their symptoms with a combination of medical treatments and lifestyle modifications. Many people find lifestyle modifications (diet, WEIGHT LOSS AND WEIGHT MANAGEMENT, SMOKING CESSATION) combined with ANTACIDS adequate, while other people require stronger medications such as H2 blockers or PPIs. Many H2 blockers are available in over-thecounter formulas. Reducing gastric acid significantly reduces the amount reflux that can backwash into the esophagus.

The most common surgical treatment for GERD that fails to improve with medication and lifestyle methods, fundoplication, reinforces the upper section of the stomach (the fundus) to increase tension on the lower esophageal sphincter. There are several fundoplication methods, some of which the surgeon can perform laparoscopically and others that require OPEN SURGERY. Another surgical option is endoscopic gastroplasty to repair or strengthen the lower esophageal sphincter. The most common complications after surgery are INFECTION and difficulty swallowing.

Treatments for Gastroesophageal Reflux Disorder (GERD)
Medical MethodsSurgical MethodsLifestyle Methods
H2 BLOCKERS
PPIS
antibiotics for H. PYLORI
ANTACIDS
fundoplication
endoscopic gastroplasty

WEIGHT LOSS AND WEIGHT MANAGEMENT
elevate head of bed
SMOKING CESSATION
avoid CAFFEINE and ALCOHOL
reduce carbonated beverages
stay upright for 2 hours after meals
sleep lying on the left side
avoid NSAIDS and aspirin

Risk Factors and Preventive Measures

Doctors are uncertain what causes GERD to develop, though various factors appear to contribute. Among them are

  • OBESITY
  • cigarette smoking
  • H. pylori
  • ASTHMA
  • eating within two hours of going to bed
  • heavy ALCOHOL consumption

Preventive measures include avoiding or minimizing factors associated with GERD as well as eating smaller meals and getting regular physical exercise, which helps maintain effective PERISTALSIS and gastrointestinal motility (movement of food through the gastrointestinal tract).

See also ACHALASIA; BARRETT’S ESOPHAGUS; ENDOSCOPY; ESOPHAGITIS.

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The Gastrointestinal System

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