Gerd

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LAPAROSOPIC SURGERY FOR GASTROESOPHAGEAL REFLUX DISEASE
Gastroesophageal reflux is the most common gastrointestinal disorder of the western world. Gallup poles have elucidated that approximately 44 % of the adult population in the U.S. has some abnormal reflux of acidic gastric juices into the esophagus on a monthly basis. Roughly 10% of patients require daily acid suppression medication for relief of symptoms. GERD accounts for over 1.0 million out patient visits to physicians every year! Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly, and stomach contents splash back, or reflux, into the esophagus. The LES is a ring of muscle located at the far end of the esophagus as it leads into the stomach. It's normal function is to act as a physical barrier between the esophagus and the stomach, protecting the esophagus from harmful gastric acid, and preventing food from being regurgitated. It does this by involuntary tonic contraction. When one eats, food is propelled into the esophagus toward the stomach. It is during swallowing that the LES relaxes and allows passage of food and liquids into the stomach. When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, which can eventually lead to more serious health problems.

What are the symptoms of GERD?
The main symptoms of GERD can be divided into typical and atypical symptoms.

Typical symptoms include a burning sensation in the chest, and regurgitation of food. These symptoms are general, and not necessarily specific for reflux disease. For instance, patients may experience chest pain or burning as a result of a primary cardiac problem, or they may be a manifestation of another primary esophageal disorder. It is imperative that the cause of the symptoms be clearly delineated by your physician so the proper therapy may be instituted. Regurgitation is also a relatively common complaint. Atypical symptoms of GERD include:

asthma;
chronic sinusitis;
chronic hoarseness;
difficulty swallowing
vomiting;
choking sensation at night time;
excessive salivation.;

What causes GERD?
The basic problem in patients with reflux disease is a defective lower esophageal sphincter (LES). If the LES is loose, then the barrier between the stomach and esophagus is compromised and gastric juice and food are allowed to flow freely back into the esophagus. Hiatal hernias (see figure) are sometimes contributing factors. This is an entity in which the normally intra-abdominal portion of the esophagus "slides" or "slips" up into the chest. In doing so, the pressure in that portion of the esophagus now becomes low enough so the intra-abdominal pressure of the stomach is high enough to overcome the natural barrier of the LES, causing reflux. Certain medical conditions, foods and medications may also exacerbate GERD by their ability to lower the resting pressure of the LES. These include: MEDICAL CONDITIONS

Obesity
Pregnancy
PERSONAL HABITS
Alcohol use
Smoking AGGRAVATING FOODS
Chocolate
Caffeine(+, -)
Spearmint
Peppermint
Fatty foods
Cola
Milk
Citrus juices
MEDICATIONS
CAN DECREASE LES PRESSURE
oral contraceptives
nitrates
theophllyine
narcotics
calcium channel blockers
ß-adrenergic agonists
a-adrenergic agonists
diazepam
dopamine
nicotine patchCAN DIRECTLY INJURE ESOPHAGEAL LINING
aspirin
NSAIDS (i.e.: ibuprofen)
quinidine
tetracycline
potassium
iron

How Is GERD Treated?
If you have had persistent heartburn or other persistent symptoms, you should consult with a physician. You may decide to visit an internist, a doctor who specializes in internal...
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