GASTRO ESOPHAGEAL REFLUX DISEASE (GERD)
General Description of GERD
It is one of the most common diseases, greatly affecting health care and contributing to the expenditure in the United States of nearly 12 billion dollars per year for antacid medications. GERD affects nearly equal proportions of men and women, but a male predominance occurs in esophagitis and Barrett’s esophagus. Increasing age is an important factor in the prevalence of GERD complications, probably the result of cumulative acid injury overtime to the esophagus.
In a nationwide population-based study by the Gallup Organization in the US, 44% of the respondents reported heartburn at least once a month. On the basis of symptoms, GERD is common in Western countries. Obesity has been associated as a contributory factor in the increase prevalence of GERD in western populations. Along with environmental factors, the epidemiology of GERD may also be attributed to genetics. The genetic mechanisms are unknown but maybe related to a smooth muscle disorder associated with hiatal hernia, reduced lower esophageal sphincter (LES) pressure and impaired esophageal motility
Gastroesophageal reflux disease is a consequence of the failure of the normal antireflux barrier to protect against frequent and abnormal amounts of gastroesophageal reflux. It is the gastric contents moving effortlessly from the stomach to the esophagus. It is a normal physiologic process that occurs
multiple times each day especially after large meals.
Possible factors determining whether reflux occurs include abdominal straining, presence of hiatal hernia and degree of esophageal shortening and duration of transient lower esophageal sphincter relaxations. Pregnancy also increases the risk of reflux by increasing intraabdominal pressure and through hormonal mechanisms. In addition, pharmacologic agents such as progesterone-containing medications (birth control pills), narcotics, benzodiazepines, calcium-channel blockers and theophylline may decrease the pressure of LES.
The relationship of H. pylori and GERD has been one of controversy. Some early studies suggested that eradication of H. pylori infection in the setting of duodenal ulcer disease would result in an increase in erosive esophagitis and GERD symptoms. Although there are several studies to support this, the weight of the evidence suggests strongly that eradication of H. pylori has no effect on the development of heartburn and in fact does not exacerbate GERD symptoms when they are present at baseline.
Most common clinical manifestations are heartburn which is a burning feeling rising from the stomach or lower chest and radiating toward the neck, throat and occasionally back, regurgitation, chest pain, dysphagia. Symptoms occur after eating large meals, or after ingesting spicy foods, citrus products, fats, chocolates, caffeine and alcohol. These symptoms are related to reflux esophagitis or inflammation of the esophagus which is due to highly acidic reflux stomach contents.
Persistent GERD causes complications which includes esophageal strictures, Barrett esophagus (columnar tissue replacing the normal squamous epithelium of the distal esophagus, which is a significant risk for esophageal cancer). Pulmonary symptoms include cough, asthma, and laryngitis which are due to reflux into the breathing passages.
Less Common Symptoms:
Water brash = sudden appearance in the mouth of a slightly sour or salty fluid Odynophagia = a severe sensation of burning, squeezing pain while swallowing caused by irritation of the esophagus burping
Older patients are asymptomatic due to decreased acidity of the reflux material
Barretts’s Esophagus = the lining of the esophagus is damaged by stomach acid and becomes like the lining of the stomach....
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