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Gastroesophageal Reflux Disease | GERD

What is Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease Causes Symptoms and Treatment

 

What is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease, also known as GERD or acid reflux, is a chronic digestive condition in which stomach acid or, infrequently, stomach content flows back up into the esophagus due to a weak sphincter muscle, spontaneous transient lower esophageal sphincter relaxations (TLESRs), or hiatal hernia. In most conditions this usually occurs when the lower esophageal sphincter (LES) does not work properly. Common symptoms of acid reflux include palpitations, regurgitation, dyspepsia, a sour or bitter taste in the mouth, and heartburn or acid indigestion.

Gastroesophageal reflux disease is especially common among pregnant women in U.S.

Without prompt treatment, acid reflux irritates the lining of your esophagus and results in either symptoms or complications.

What is the lower esophageal sphincter responsible for?

The lower esophageal sphincter (LES) is a ring of muscle in the lower esophagus at the esophagogastric junction that open to allow food and close to prevent gastric acid and stomach content from moving back up into the esophagus. Relaxation of the esophageal sphincter allows the transport of ingested contents from the esophagus into the stomach (swallow-induced LES relaxation); however, retrograde flow of gastric acid and stomach content into the esophagus can also occur in the absence of swallow due to transient LES relaxation (TLESR)

What controls the lower esophageal sphincter?

The lower esophageal sphincter is innervated by both sympathetic (the splanchnic nerves) and parasympathetic (the vagus nerves) nerves; however, the vagus nerves are responsible for reflex relaxation of the lower esophageal sphincter (LES). Transient LES relaxations are mediated by gastric vagal afferent stimulation

Why does my food come back up after I eat?

The lower esophageal sphincter (also called the cardiac sphincter or cardioesophageal sphincter) normally prevents gastric acid and stomach content from moving back up into the esophagus. However, when this sphincter does not close all the way, gastric acid and stomach content can flow back up into the esophagus. This is called reflux or gastroesophageal reflux.

What are the risk factors for gerd?

Conditions that can increase your risk of GERD include: gastric hyperacidity, pregnancy, obesity, and structural problems, such as hiatal hernia

What is the meaning of acid reflux?

Acid reflux is a condition characterized by effortless regurgitation of gastric acid and undigested food from the stomach back up into the esophagus and then into the larynx (voice box), oropharynx (the back of your throat) and/or the nasopharynx. This condition is often accompanied by a burning pain in the epigastrium (epigastric pain).

Heartburn is caused by acid reflux which is when gastric acid flows back up into the esophagus.

Is GERD common?

Gastroesophageal reflux disease (GERD) affects people of all backgrounds, regardless of religion, sex, race or ethnicity, although women (especially pregnant ones) report the condition more often than men. About 60% of the adult population worldwide will experience some of the most common symptoms of GERD at some point in their lives; However, in this case, symptoms usually resolve within a 12 month period. Up to 30% of the adult population worldwide suffer from acid reflux on a daily or weekly basis.

Around 7 million adults in the United States suffer from symptoms of acid reflux disease

Symptoms

What are symptoms of acid reflux in adults?

Common symptoms of acid reflux in adults include:

  1. Frequent heartburn or acid indigestion, (a burning feeling in your chest or throat)
  2. A sour or bitter taste in the mouth, from regurgitated gastric acid and stomach contents
  3. Cough, sore throat, and chronic hoarseness of voice due to reflux laryngitis or inflammation of the voice box (larynx), from regurgitated gastric acid and stomach contents
  4. Globus pharyngeus (globus Sensation), the persistent sensation of having a lump or phlegm in your throat when no lump or phlegm is actually there. Commonly people describe this as a tightness in the throat which is felt when swallowing saliva
  5. Tooth decay or tooth erosion due to the reflux of hydrochloric acid from the stomach. Gastric acid that backs up into the mouth can destroy the protective enamel of the teeth. Affected teeth can be fragile and discolored
  6. Palpitations
  7. Dysphagia or difficulty swallowing
  8. Burning in the throat
  9. Epigastric and chest pain

How long do the symptoms of acid reflux last?

Without prompt treatment, in most cases, symptoms usually last up to 2 hours. However, occasionally heartburn symptoms may last longer and may cause a variety of symptoms, including: sleep problems, choking, wheezing, headaches (due to vagus nerve irritation) and laryngeal symptoms such as sore throat, hoarseness, chronic cough, dysphonia (difficulty speaking due sore throat) and globus. Symptoms of acid reflux usually occur after eating and get worse if you bend over or lie down. Heartburn gets better if you stand up or sit.

Without prompt treatment, acid reflux can trigger asthma

Can acid reflux give you a headache?

Acid reflux can cause cluster headaches due to desaturation of oxygen (gastroesophageal reflux-induced hypoxemia).[1][2][3] Moreover, In many cases, symptoms of acid reflux are triggered by vagus nerve irritation due to a compression of the vagus nerve, and in this case, symptoms of acid reflux may include headaches, nausea, dizziness (vertigo), stomach acidity, facial flushing (redness of the face), difficulty in swallowing, and palpitations or tachycardia

Normally, The vagus nerve increases secretion of gastric acid in the stomach, gastrointestinal (GI) motility and other digestive juices, as the upper cervical vagus nerve controls heart, headache and stomach function, and thus vagus nerve irritation due to compression may cause a variety of symptoms, including indigestion, heart palpitations, nausea, tension headache, shortness of breath (dyspnea), dull chest pains, diarrhea, constipation and gastritis. This clinical picture is common in a patient with a hiatal hernia

Causes

What causes gastroesophageal reflux disease?

What causes GERD in adults?

Reflux esophagitis is an esophageal mucosal injury that occurs when stomach acid or, infrequently, stomach content flows back up into the esophagus and then into the larynx, oropharynx and/or the nasopharynx due to a weak sphincter muscle, spontaneous transient lower esophageal sphincter relaxations (TLESRs), or hiatal hernia. Clinically, this is known as gastroesophageal reflux disease (GERD) or acid reflux disease. Less commonly, GERD can also be caused by delayed gastric emptying.

Acid Reflux Disease gerd

In most conditions, GERD involves the distal 10 cm of the esophagus and the gastroesophageal junction.

Low stomach acid or hypochlorhydria can cause GERD like symptoms, as it can lead to atypical alkaline reflux (non-acid reflux) symptoms in some people. Hypochlorhydria is common in patients with chronic atrophic gastritis (CAG)

How do you develop GERD?

Several factors can increase your risk of GERD this includes stomach abnormalities, obesity, pregnancy, unhealthy diet, changes in human body with age, genetic predisposition, work-related diseases and injuries, post therapeutic injuries (after an endoscopy), some medications, lifestyle, and strength training sports such as weight lifting and bodybuilding.

In most cases, symptoms of acid reflux disease occur in patients with hiatal hernia when the upper part of the stomach (the gastric fundus and cardia) and lower esophageal sphincter (LES) move above the diaphragm. Alternatively, symptoms of acid reflux disease can also occur due to a weak sphincter muscle, or spontaneous transient lower esophageal sphincter relaxations (TLESRs).

What is the cause of chronic heartburn?

Heartburn is an irritation that occurs when stomach acid or, infrequently, stomach content flows back up into the esophagus. This mucosal injury can cause epigastric pain and palpitations (fluttering in chest). If left untreated, chronic heartburn can sometimes lead to serious problems.

What foods and drinks cause acid reflux?

Foods and drinks that commonly trigger heartburn include:

  1. Alcoholic beverages, particularly red wine.
  2. Raw onion and garlic, and other alliums
  3. Black pepper, and other spicy foods.
  4. Dark chocolate
  5. Citrus fruits and juices, such as lime and orange juice
  6. Caffeinated drinks, including sodas, coffees, energy drinks, and teas
  7. Highly acidic fruits, including pomegranates (pH: 2.93 – 3.20), grapefruits (pH: 3.00 – 3.75), and blueberries (pH: 3.12 – 3.33)
  8. Acidic vegetables, including sauerkraut (pH: 3.30–3.60), canned tomatoes (pH: 3.5 -4.0), cabbage (pH: 5.20–6.80), beets (pH: 5.30–6.60)
  9. Sodas and other sweetened beverages
  10. Peppermint and spearmint (pH: 5.5-6.0)

Diagnosis

How to diagnose gastroesophageal reflux disease?

Your doctor may be able to diagnose GERD based on the frequency of heartburn episodes, in addition to other symptoms of acid reflux disease. GERD can be confirmed by lab tests

How do you get tested for acid reflux?

The four main tests used when GERD is suspected are ambulatory 24-hour esophageal ph monitoring test, barium swallow test, endoscopy, and esophageal manometry.

What is esophageal ph monitoring?

The esophageal pH test is an outpatient procedure used to measure the pH or the amount of gastric acid that regurgitates into the esophagus over a 24-48 hour period. During gastroesophageal reflux episodes the intraesophageal pH drops from 5.5 to below 4.0

This test uses the Bravo Capsule that contains an acid sensing probe, a battery, and a transmitter, to measure and identify when, and for how long, stomach acid regurgitates into your esophagus on a 24 hours basis

What is the normal ph level of the esophagus?

Normal esophageal pH ranges between 7.30 and 7.45. A pH less than 7.0 is considered to be acidic, whereas a pH greater than 7.0 is said to be basic or alkaline.

What is a barium swallow test and how long does the barium swallow test take?

A barium swallow test is an outpatient X-ray imaging test in which the patient swallows a thick, milk-like flavored liquid containing the barium sulfate while X-ray images are obtained to visualize and evaluate the esophagus, stomach, and duodenum. The test takes about 30 minutes. This test is used to detect significant abnormalities in the upper gastrointestinal (GI) tract and to determine the cause of heartburn, dyspepsia, dysphagia, odynophagia (pain when swallowing), hematemesis (blood in vomit), epigastric pain, or unexplained weight loss. The test involves exposure to ionizing radiation. To prepare, patients are asked not to eat or drink for at least 6 hours before the test.

What can you see with a barium swallow?

A barium swallow test is used to detect significant abnormalities in the upper gastrointestinal (GI) tract. Some abnormalities that may be detected by a barium swallow include hernias, esophageal diverticula, tumors, ulcers, strictures, inflammation, and esophageal motility abnormalities.

What is esophageal manometry used for and how is esophageal manometry done?

Esophageal manometry test is an outpatient procedure in which a catheter containing fluid-filled or solid-state pressure transducers is passed through the mouth into the esophagus. This test is used to evaluate the function of the lower esophageal sphincter and to see if the esophagus is contracting and relaxing properly. The cost of an Esophageal Manometry ranges from five hundred to seven hundred us dollars

Treatment

What are the treatment options for GERD and what do you take for GERD?

The goal of treatment is to manage and reduce symptoms, to heal reflux esophagitis, and to prevent recurrence of esophagitis after treatment. Treatment options for acid reflux include changes in lifestyle, diet, and habits and control of gastric acid secretion through medical therapy with over the counter (OTC) and prescription drugs, and in severe cases, surgical treatment with corrective antireflux surgery.

Common over-the-counter (OTC) medications that may help control heartburn include:

  1. Antacids that neutralize stomach acid, such as Maalox, Mylanta, Rolaids, Gelusil, Gaviscon, and Tums
  2. Proton pump inhibitors (PPIs) that block acid production and allow time for the esophagus to heal, such as omeprazole (Prilosec OTC, Zegerid OTC, Losec), lansoprazole (Prevacid 24 HR), esomeprazole (Nexium 24HR), and others
  3. H2-blockers (histamine(2) receptor antagonists) that decrease the production of gastric acid, such as Tagamet (cimetidine), Zantac (ranitidine), Nizatidine (Axid), and Pepcid (famotidine)

Common prescription medications include:

  1. Coating agents, such as Sucralfate (Carafate)
  2. Promotility agents (prokinetic agents), such as metoclopramide (Reglan, Reglan ODT, Metozol ODT, Octamide, Clopra, Maxolon), and cisapride (Propulsid®, Prepulsid)

How to treat gastroesophageal reflux disease and what is the best treatment for acid reflux disease?

Treatment options include changes in lifestyle, diet, and habits and medications, the use of combination therapy with proton-pump inhibitors (PPIs) and H2-blockers in gastroesophageal reflux disease may provide greater efficacy, fewer side effects, and greater response rates. Ranitidine in combination with omeprazole and maalox are often used for the treatment of GERD. These three drugs are usually the first drugs recommended to relieve heartburn and other symptoms of acid reflux

How to treat alkaline reflux symptoms naturally?

Apple cider vinegar (cider vinegar or ACV) can be beneficial in several ways if your heartburn is caused by hypochlorhydria, as it  contains mother of vinegar, and thus can be used to increase stomach acid naturally. For best results, add lemon juice to a glass of water with two teaspoons of apple cider vinegar and drink it right before bed each night, after meals or before meals to enhance digestion.

How can I relieve acid reflux and how do you reduce stomach acid naturally?

Eat an apple, a banana or grapes. Natural antacid foods can act as a buffer against acid reflux. Try an apple a day or try eating a ripe banana a day to get rid of heartburn (acid reflux) quickly. Alternatively, drink aloe vera juice or pineapple juice, these juices provide a fast heartburn relief

By eating a ripe banana per day, you provide your body with about 500 mg of potassium

How to ripen bananas overnight?

Place bananas in a plastic bag with a ripe apple and put the bag under a blanket and cover it well for at least 12 hours and then check from time to time at certain intervals in order to pick them out at your desired ripeness. Alternatively, place bananas in a paper bag with a ripe apple, then leave the bag in a dark room, with the top slightly open. Check from time to time at certain intervals in order to pick your fruits at your desired ripeness. Refrigerate when the bananas reach the desired ripeness to keep it at it’s peak of ripeness for a couple of days.

How do you heal GERD?

Top 12 Ways to Prevent GERD

Knowing your triggers can help manage and prevent heartburn. If you have been suffering from persistent heartburn (chronic or uncontrollable heartburn) or any other symptoms of acid reflux for a long time, you might want to try the following steps:

1. Eat 5 to 8 small meals a day

Eating 5 to 8 small meals can actually help you manage acid reflux and other symptoms of GERD. The frequency of heartburn and acid regurgitation increases when the stomach is very full.

2. Avoid certain foods

Eliminate foods and drinks that commonly trigger heartburn, including spicy foods, junk food, mint, fatty foods, onions, garlic, chocolate, coffee, tea, alcohol, and acidic foods, like citrus and tomatoes

Stop drinking alcohol as it can cause the LES to relax and allow acid reflux. Moreover, alcohol can also cause esophageal spasm.

3. Don’t drink soft drinks

Fizzy drinks (carbonated and energy drinks) make you burp, which allows food and acidic stomach juices to flow back into the esophagus. Fizzy drinks contain carbonated water, a natural or artificial flavoring, and a sweetener or sugar.

Drink tap water instead of carbonated beverages or sparkling water because drinking sparkling water causes burping, bloating, gas and abdominal discomfort.

4. Stay up after eating

Gravity can prevent gastric acid and stomach contents from flowing back up into the esophagus while standing or sitting. In most cases, GERD usually occurs when the lower esophageal sphincter (LES) does not close properly, so in this case, acid reflux occurs especially after bending over or lying down, and for this reason finish eating at least two hours before going to bed. This means no late suppers and no naps after lunch.

After you eat, it takes about 6-8 hours for food to pass through the upper gastrointestinal tract (GI) tract.

5. Avoid wrong type of exercise

Eat 2-3 hours before working out and avoid strenuous workouts that involve bending over, like weightlifting and jumping, as it can induce acid reflux

6. Try sleeping with your bed elevated

Ideally, elevate the head of the bed slightly by 10-15 degrees, so that your head is slightly higher than your chest and your heart is 6 to 8 inches (15-20 cm) higher than your legs. Use a foam bed wedge pillow to raise head and torso or use a slightly higher pillow to raise your head more than a few inches to help relieve acid reflux

7. Get in shape and lose belly fat

Increased belly fat puts great pressure on the internal organs and pushes the diaphragm upwards into the chest, decreasing the pressure that holds the lower esophageal sphincter (LES) closed. This in turn leads to reflux and heartburn

Abdominal pressure can push gastric juices up into your esophagus

8. Quit smoking

Smoking cigarettes causes the release of nitric oxide (NO), a mediator that acts as a noncholinergic nonadrenergic neurotransmitter, which, in turn produces smooth muscle relaxation at various sites in the gastrointestinal tract. In most cases, nicotine speeds up stomach emptying

The reduced lower esophageal sphincter (LES) pressure may increase your risk for acid reflux disease or GERD.

Gastroesophageal reflux (GERD) may occur freely in the absence of lower esophageal sphincter (LES) pressure

9. Check your medications

Many drugs can increase your risk for acid reflux disease, either by relaxing the lower esophageal sphincter, interfering with digestion, or further irritating an already inflamed lining of the esophagus. These drugs include:

  1. Postmenopausal estrogen replacement therapy (HRT), systemic estrogens that come in skin patches, pills, gels, creams or spray forms, can also trigger symptoms of acid reflux, such as heartburn
  2. Bisphosphonates, like ibandronate (Boniva), alendronate (Fosamax) or risendronate (Actonel), which are used to boost bone density, can irritate the esophagus
  3. Tricyclic antidepressants, can cause acid reflux and heartburn, as they can relax the lower esophageal sphincter LES
  4. Non-steroidal anti-inflammatory drugs, or NSAIDs, can relax the lower esophageal sphincter LES
  5. Calcium channel blockers, which are often used to treat hypertension can trigger symptoms of acid reflux
  6. Beta-agonists like albuterol, which are used to treat asthma, can also trigger symptoms of acid reflux
  7. Anticholinergics, which are used to treat conditions such as seasonal allergies and glaucoma, can trigger symptoms of acid reflux
  8. Potassium and iron tablets
  9. Sedatives and painkillers
  10. Some antibiotics

If you use any of these medications, you should consider switching into an alternative drug that does not have the same effect on the upper digestive tract.

10. Wear loose clothes

Wear loose clothes, as tight clothes or belts can constrict your stomach.

11. Try a gluten-free diet

Gluten may worsen symptoms of acid reflux. Try eliminating gluten from your diet and see if gerd symptoms respond or persist despite eliminating gluten, a protein found in grains like wheat, barley, and rye

12. Consider taking a probiotic dietary supplement

Can probiotics help with acid reflux?

Start taking probiotics. There are many types of probiotics. Some are in foods like kefir or yogurt. Probiotic dietary supplements are commonly used to treat many gastrointestinal conditions that may trigger unpleasant acid reflux symptoms, such as crohn’s disease, IBS, meteorism, etc.

If the above steps or tips aren’t effective and you are still experiencing GERD, see your doctor in order to evaluate your condition fully and to rule out other causes, you may need to take medicines. There are medications you can take to control reflux.

 

 

 

 

 

References

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