Gastroesophageal reflux disease is a condition in which stomach acid repeatedly flows back up into the tube connecting the mouth and stomach, called the esophagus. It's often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus.
Many people experience acid reflux now and then. However, when acid reflux happens repeatedly over time, it can cause GERD.
Causes:
GERD may develop if your lower esophageal sphincter becomes weak or relaxes when it shouldn’t. This result in reflux of stomach acid into the esophagus.
GERD may also develop in patients having hiatal hernia, which is moving up of the stomach into the chest cavity through a defect in diaphragm.
Symptoms:
Common symptoms of GERD include:
1)A burning sensation in the chest, often called heartburn. Heartburn usually happens after eating and might be worse at night or while lying down.
2) Backwash of food or sour liquid in the throat.
3)Upper belly or chest pain.
4) Trouble swallowing, called dysphagia.
5) Sensation of a lump in the throat.
If you have nighttime acid reflux, you also might experience:
1)An ongoing cough.
2) Inflammation of the vocal cords, known as laryngitis.
3) New or worsening asthma.
Some lifestyle issues that can cause GERD may include:
1)Being overweight
2) Overeating
3) Pregnancy
4) Eating foods such as citrus, chocolate, and fatty or spicy foods
5) Having caffeine, alcohol
6) Smoking
7) Using aspirin and over-the-counter pain and fever medicines.
Diagnosis:
1) History and physical examination.
2) Investigations:
Upper endoscopy- An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine the upper digestive system. The camera helps provide a view of the inside of the esophagus and stomach. Test results may not show when reflux is present, but an endoscopy may find inflammation of the esophagus or other complications.
An endoscopy also can be used to collect a sample of tissue, called a biopsy, to be tested for complications such as Barrett esophagus.
Ambulatory acid (pH) probe test. A monitor is placed in the esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that's worn around the waist or with a strap over the shoulder.
X-ray of the upper digestive system. X-rays are taken after drinking a chalky liquid that coats and fills the inside lining of the digestive tract. The coating allows a healthcare professional to see a silhouette of the esophagus and stomach. This is particularly useful for people who are having trouble swallowing.
X-ray can also diagnose narrowing of esophagus causing difficulty in swallowing.
Esophageal manometry. This test measures the rhythmic muscle contractions in the esophagus while swallowing. Esophageal manometry also measures the coordination and force exerted by the muscles of the esophagus. This is typically done in people who have trouble swallowing.
Treatment:
1) Lifestyle modification
a) Decrease weight
b) Avoid caffeine, smoking, alcohol
c) Avoid foods causing GERD
Medicines:
Like antacids and PPI, H2 blockers to decrease acid production and reflux of acids.
2) Surgery:
Normally GERD responds well to lifestyle modification and medications.
If it fails and patient is very much symptomatic then fundoplication is suggested.
コメント