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| Gastroesophageal reflux
disease like
any disease comes about as a malfunction of one or more of your
bodies systems. Much if not most of the time this is a
result of a slow degenerative process due to the lack of adequate
bodily supplies of the elements necessary for normal function and
rejuvenation of affected organs. Commercial Farming and natural
erosion has depleted global farmlands of most essential elements
therefore it is not wise to assume that your diet contains enough
of these elements for normal body function and maintenance.
See
Senate Document 264.
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Gastroesophageal
reflux disease (GERD) is a digestive disorder that affects the
lower esophageal sphincter (LES)--the muscle connecting the
esophagus with the stomach. Many people, including pregnant women,
suffer from heartburn or acid indigestion caused by GERD. Doctors
believe that some people suffer from GERD due to a condition
called hiatal hernia. In most cases, heartburn can be relieved
through diet and lifestyle changes; however, some people may
require medication or surgery. This fact sheet provides
information on GERD-its causes, symptoms, treatment, and long-term
complications.
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What Is Gastro-
esophageal Reflux?
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Gastroesophageal
refers to the stomach and esophagus. Reflux means to flow back or
return. Therefore, gastroesophageal reflux is the return of the
stomach's contents back up into the esophagus.
Figure 1 |
In normal digestion, the LES opens to allow food to
pass into the stomach and closes to prevent food and acidic
stomach juices from flowing back into the esophagus.
Gastroesophageal reflux occurs when the LES is weak or relaxes
inappropriately allowing the stomach's contents to flow up into
the esophagus. Figure 1 shows the location of the LES
between the esophagus and the stomach.
The severity of GERD depends on LES dysfunction
as well as the type and amount of fluid brought up from the
stomach and the neutralizing effect of saliva.
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What Is the Role of Hiatal Hernia?
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Some
doctors believe a hiatal hernia may weaken the LES and cause
reflux. Hiatal hernia occurs when the upper part of the stomach
moves up into the chest through a small opening in the diaphragm
(diaphragmatic hiatus). The diaphragm is the muscle separating the
stomach from the chest. Recent studies show that the opening in
the diaphragm acts as an additional sphincter around the lower end
of the esophagus. Studies also show that hiatal hernia results in
retention of acid and other contents above this opening. These
substances can reflux easily into the esophagus.
Coughing, vomiting, straining, or sudden
physical exertion can cause increased pressure in the abdomen
resulting in hiatal hernia. Obesity and pregnancy also contribute
to this condition. Many otherwise healthy people age 50 and over
have a small hiatal hernia. Although considered a condition of
middle age, hiatal hernias affect people of all ages.
Hiatal hernias usually do not require treatment.
However, treatment may be necessary if the hernia is in danger of
becoming strangulated (twisted in a way that cuts off blood
supply, i.e., paraesophageal hernia) or is complicated by severe
GERD or esophagitis (inflammation of the esophagus). The doctor
may perform surgery to reduce the size of the hernia or to prevent
strangulation.
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What Other Factors Contribute to GERD?
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Dietary and
lifestyle choices may contribute to GERD. Certain foods and
beverages, including chocolate, peppermint, fried or fatty foods,
coffee, or alcoholic beverages, may weaken the LES causing reflux
and heartburn. Studies show that cigarette smoking relaxes the
LES. Obesity and pregnancy can also cause GERD.
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What Does Heartburn Feel Like?
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Heartburn,
also called acid indigestion, is the most common symptom of GERD
and usually feels like a burning chest pain beginning behind the
breastbone and moving upward to the neck and throat. Many people
say it feels like food is coming back into the mouth leaving an
acid or bitter taste.
The burning, pressure, or pain of heartburn can
last as long as 2 hours and is often worse after eating. Lying
down or bending over can also result in heartburn. Many people
obtain relief by standing upright or by taking an antacid that
clears acid out of the esophagus.
Heartburn pain can be mistaken for the pain
associated with heart disease or a heart attack, but there are
differences. Exercise may aggravate pain resulting from heart
disease, and rest may relieve the pain. Heartburn pain is less
likely to be associated with physical activity.
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How Common Is Heartburn?
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More than
60 million American adults experience Gerd and heartburn at least
once a month, and about 25 million adults suffer daily from
heartburn. Twenty-five percent of pregnant women experience daily
heartburn, and more than 50 percent have occasional distress.
Recent studies show that GERD in infants and children is more
common than previously recognized and may produce recurrent
vomiting, coughing and other respiratory problems, or failure to
thrive.
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What Is the Treatment for GERD?
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Doctors
recommend lifestyle and dietary changes for most people with GERD.
Treatment aims at decreasing the amount of reflux or reducing
damage to the lining of the esophagus from refluxed materials.
Avoiding foods and beverages that can weaken the
LES is recommended. These foods include chocolate, peppermint,
fatty foods, coffee, and alcoholic beverages. Foods and beverages
that can irritate a damaged esophageal lining, such as citrus
fruits and juices, tomato products, and pepper, should also be
avoided.
Decreasing the size of portions at mealtime may
also help control symptoms. Eating meals at least 2 to 3 hours
before bedtime may lessen reflux by allowing the acid in the
stomach to decrease and the stomach to empty partially. In
addition, being overweight often worsens symptoms. Many overweight
people find relief when they lose weight.
Cigarette smoking weakens the LES. Therefore,
stopping smoking is important to reduce GERD symptoms.
Elevating the head of the bed on 6-inch blocks
or sleeping on a specially designed wedge reduces heartburn by
allowing gravity to minimize reflux of stomach contents into the
esophagus.
Antacids taken regularly can neutralize acid in
the esophagus and stomach and stop heartburn. Many people find
that nonprescription antacids provide temporary or partial relief.
An antacid combined with a foaming agent such as alginic acid
helps some people. These compounds are believed to form a foam
barrier on top of the stomach that prevents acid reflux from
occuring.
Long-term use of antacids, however, can result
in side effects, including diarrhea, altered calcium metabolism (a
change in the way the body breaks down and uses calcium), and
buildup of magnesium in the body. Too much magnesium can be
serious for patients with kidney disease. If antacids are needed
for more than 3 weeks, a doctor should be consulted.
For chronic reflux and heartburn, the doctor may
prescribe medications to reduce acid in the stomach. These
medicines include H2 blockers, which inhibit acid secretion in the
stomach. Currently, four H2 blockers are available: cimetidine,
famotidine, nizatidine, and ranitidine. Another type of drug, the
proton pump (or acid pump) inhibitor omeprazole inhibits an enzyme
(a protein in the acid-producing cells of the stomach) necessary
for acid secretion. The acid pump inhibitor lansoprazole is
currently under investigation as a new treatment for GERD.
Other approaches to therapy will increase the
strength of the LES and quicken emptying of stomach contents with
motility drugs that act on the upper gastrointestinal (GI) tract.
These drugs include bethanechol and metoclopramide.
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Tips To Control Heartburn
- Avoid foods and beverages that affect
LES pressure or irritate the esophagus lining,
including fried and fatty foods, peppermint,
chocolate, alcohol, coffee, citrus fruit and juices,
and tomato products.
- Lose weight if overweight.
- Stop smoking.
- Elevate the head of the bed 6 inches.
- Avoid lying down 2 to 3 hours after
eating.
- Take an antacid.
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People with
severe, chronic esophageal reflux or with symptoms not relieved by
the treatment described above may need more complete diagnostic
evaluation. Doctors use a variety of tests and procedures to
examine a patient with chronic heartburn.
An upper GI series may be performed
during the early phase of testing. This test is a special x-ray
that shows the esophagus, stomach, and duodenum (the upper part of
the small intestine). While an upper GI series provides limited
information about possible reflux, it is used to rule out other
diagnoses, such as peptic ulcers.
Endoscopy is an important procedure for
individuals with chronic GERD. By placing a small lighted tube
with a tiny video camera on the end (endoscope) into the
esophagus, the doctor may see inflammation or irritation of the
tissue lining the esophagus (esophagitis). If the findings of the
endoscopy are abnormal or questionable, biopsy (removing a
small sample of tissue) from the lining of the esophagus may be
helpful.
The Bernstein test (dripping a mild acid
through a tube placed in the mid-esophagus) is often performed as
part of a complete evaluation. This test attempts to confirm that
the symptoms result from acid in the esophagus. Esophageal
manometric studies-pressure measurements of the
esophagus-occasionally help identify critically low pressure in
the LES or abnormalities in esophageal muscle contraction.
For patients in whom diagnosis is difficult,
doctors may measure the acid levels inside the esophagus through
pH testing. Testing pH monitors the acidity level of the esophagus
and symptoms during meals, activity, and sleep. Newer techniques
of long-term pH monitoring are improving diagnostic capability in
this area.
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Does GERD Require Surgery?
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A small
number of people with GERD may need surgery because of severe
reflux and poor response to medical treatment. Fundoplication is a
surgical procedure that increases pressure in the lower esophagus.
However, surgery should not be considered until all other measures
have been tried.
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What Are the Complications of Long-Term GERD?
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Sometimes
GERD results in serious complications. Esophagitis can occur as a
result of too much stomach acid in the esophagus. Esophagitis may
cause esophageal bleeding or ulcers. In addition, a narrowing or
stricture of the esophagus may occur from chronic scarring. Some
people develop a condition known as Barrett's esophagus, which is
severe damage to the skin-like lining of the esophagus. Doctors
believe this condition may be a precursor to esophageal cancer.
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