The condition known as gastroesophageal reflux disease (GERD) or acid reflux occurs when the liquid content of the stomach regurgitates into the esophagus. Although apparent signs of inflammation occur in a minority of people, the liquid can inflame and harm the lining (esophagitis).
The stomach produces acid and pepsin, which are frequently present in the regurgitated fluids. (Pepsin is a digestive enzyme that starts the digestion of proteins in the stomach.) The refluxed liquid may also contain bile from the duodenum that has backed up into the stomach.
The acid in the refluxed liquid is thought to be the most harmful component. Pepsin and bile may potentially cause esophageal injury, but their contribution to esophageal inflammation and damage is minor.
GERD is usually a lifelong condition once it starts. A persistent condition is esophagitis, which is a damage to the lining of the esophagus. Furthermore, once the esophagus has recovered as a result of treatment, most patients will experience a recurrence of the injury within a few months. However, once GERD treatment is started, it must be continued indefinitely. During symptomatic periods, however, some people with intermittent symptoms and no esophagitis can be managed.
A person’s susceptibility to GERD is determined by a number of factors. GERD, for example, can be a major issue during pregnancy. Pregnancy hormones are thought to promote reflux by reducing the pressure in the lower esophageal sphincter. At the same time, the expanding fetus raises abdominal pressure. Both of these factors are likely to increase reflux. Patients with disorders like scleroderma or mixed connective tissue diseases, which weaken the esophageal muscles, are also more likely to develop GERD.
Causes of GERD
GERD is a complicated condition with various causes. Furthermore, different factors may influence different people at different times or even the same person at different times. A tiny percentage of patients create excessive amounts of acid, however, this is unusual and not a concern in the great majority of cases.
The major causes of GERD are:
- Weakness of the muscle between the esophagus and the stomach (lower esophageal sphincter),
- Hiatal hernias: A condition where the upper part of the stomach passes through the diaphragm muscle and into the chest, making the gastroesophageal junction lax
- Aberrant esophageal contractions
- Sluggish or prolonged stomach emptying: Narcotics, tricyclic antidepressants, calcium channel blockers (CCBs), clonidine, dopamine agonists, lithium (Eskalith, Lithobid), nicotine, and progesterone are among the drugs linked to slowed stomach emptying.
Symptoms of GERD
The major symptoms of sinusitis are:
- heartburn (sometimes interpreted as chest pain)
Treatment of GERD
Certain foods are known to reduce the pressure in the lower esophageal sphincter and thereby promote reflux. These foods should be avoided and include:
- alcohol, and
- caffeinated drinks.
Medications for GERD
- Histamine antagonists e.g. cimetidine
- Proton pump inhibitors e.g. omeprazole
- Promotility drugs e.g. metoclopramide
- Foam barriers
Fundoplication is a surgical operation that is used to prevent reflux. It is also known as reflux surgery or anti-reflux surgery. Any hiatal hernial sac is pushed below the diaphragm and sewn there during fundoplication. The diaphragm aperture through which the esophagus passes is also tightened around the esophagus. Finally, the upper half of the stomach is wrapped around the lower esophagus to create an artificial lower esophageal sphincter near the entry of the esophagus into the stomach.
Endoscopic procedures for the treatment of GERD have just lately been developed and tested. Suturing (stitching) the area of the lower esophageal sphincter, which effectively tightens the sphincter, is one type of endoscopic treatment.
The administration of radio-frequency waves to the lower section of the esophagus, right above the sphincter, is the second type.
The injection of materials into the esophageal wall in the area of the lower esophageal sphincter is a third type of endoscopic treatment.