Gastroesophageal reflux

What is gastroesophageal reflux disease (GERD)?

The term GERD is meant to restore part of stomach contents into the esophagus because of damage to the sphincter between the esophagus and stomach which normally remains closed, after taking food or liquids. Regurgitation of gastric fluid creates a burning sensation, back pain and can cause ulcers in the esophagus.

How common is GERD?

The GTC is an important health problem, according to the available data, 44% of adults experience heartburn feeling, at least once a month. Corresponding data in Cypriot resident population show that 38% of people report symptoms of GERD every week.Regurgitation of stomach fluid can occur even in young children.

How is GERD occurs?

The most characteristic symptom of the disease is heartburn, a subjective symptom calcination (burning) localized to the epigastrium (upper abdomen), the outgrowth of rapier and the sternum (chest). Typically, the heartburn is felt at least 2 to 3 times a week and appear or exacerbated by taking fatty meals or bedtime. Furthermore, the presence of obesity, smoking, and alcohol consumption are aggravating factors in the regression.Other symptoms that may indicate reflux is acidic eructation (belching) and chest pain.Likely to occur and exooisofagikes events, such as:

• Hoarseness
• Chronic dry cough
• Breathlessness or choking feeling that interrupts sleep

What are the possible complications of GERD?

Patients presenting with GERD the most often not taken seriously the symptoms of reflux and either fail to visit a gastroenterologist, or trying to cope on their own symptoms with simple antacids from the chemist. In these cases the delay in early diagnosis of the severity of symptoms can result in severe and irreversible complications rare. The most serious of these include:

• nausea or vomiting (due to reflux)
• pain behind the chest (it should not be excluded that the pain does not come from the heart)
• bleeding (in patients with esophagitis, or short as vomiting blood, or anemia as a blood test)
• difficulty in passage of food from the esophagus to the stomach - difficulty in swallowing (in advanced stages of esophagitis due to narrowing of the lumen)
• weight loss (due to failure of food intake due to the difficulty in swallowing)
• Esophagus Barrett (cell destruction of the lower esophagus and replacement of these cell types stomach, resulting in increased risk of esophageal cancer)

What causes GERD?

Reflux occurs when not working well the sphincter located at the bottom of the esophagus, which normally allows the passage of food and water only from the esophagus to the stomach (presence diafragmatokoilis). Then, turning stomach contents back into the esophagus. The presence diafragmatokoilis also associated with increased incidence of transient sphincter relaxations and with reduced clearance palindromountos gastric contents into the esophagus.

How is GERD diagnosed?

Diagnosis is made with typical symptoms (heartburn, acid eructation). In cases of severe symptoms, the doctor may request an endoscopy which reveals the presence of gastric juices into the esophagus and irritation (inflammation) of the Rules of the esophagus (esophagitis) and possible complications of this (bleeding, stricture, esophagus Barrett).Patients not responding to standard treatment may be necessary to make more tests such as measurement of the acidity of gastric (stomach pH meter) and the study of esophageal motility (manometry).

How can I prevent or cope with the GTC?

Regardless of the severity of symptoms, the first step in tackling GERD is to revise the daily lifestyle.

• Stop smoking
• Lose the extra weight you
• Women Avoid tight clothing and high heels
• Raise your bed 15 - 20 cm or insert a special pillow
• Eat small meals well-chewed
• Do not lie down after lunch (please wait at least 2 to 3 hours before sleep)
• Limit fatty foods
• Avoid foods and beverages that cause reflux (caffeinated beverages, soft drinks and carbonated beverages, chewing gum, mint, chocolate, syrups, croissants, rolls, pastries, banana, sour fruit and drinks, onions, tomatoes, olives, fried and spicy foods, nuts and salt)
• Limit or avoid alcohol
• Avoid drugs and supplements that worsen reflux (cough syrups, certain medications for hypertension - calcium blockers, drugs for arrhythmia, tablets of potassium and vitamin C, antibiotics, nonsteroidal anti-inflammatory drugs, asthma medications and tranquilizers, anti-osteoporosis )

What the medicinal treatment of GERD?

The medication for the treatment of patients with reflux consists of inhibitors of the pump forestay, which inhibit acid production, and give time to the esophagus to heal from the wounds of regression.

Treatment with histamine type 2 antagonists or antacids, and used only as a complement inhibitor proton, since the success rates are significantly lower. Provide faster relief of symptoms without heal the wounds of GERD.

In some cases concomitantly premotor drugs that accelerate gastric emptying and thus reduces the fluid reflux into the esophagus.

Although the administration of proton pump inhibitors accelerate the control of reflux in most patients, in 75 - 90% of patients symptoms will recur after discontinuation of medication. For this reason, most patients involves continuing treatment over time.

When do you need surgery to treat GERD?

Surgical treatment of reflux is proposed as an alternative for:

• those who do not respond to medication
• those who do not obey the medication
• those who require high doses of PPIs for long periods (eg young age patients)

Mostly applies fundoplication Nissen, performed and laparoscopically. The failure rate is around 10%, while postoperatively, a significant percentage of patients (50 - 60%) needs to take back proton pump inhibitors. Finally, in an effort to avoid surgery in patients not responding to medication, have been developed recently and endoscopic methods of treatment of reflux, but, still have not found wide application in clinical practice.

Conclusion

Gastroesophageal reflux is a common clinical entity that usually occurs with a sense of heartburn. Typically, the heartburn is felt at least 2 to 3 times a week and appears or worsens after a fatty meal or flooding.

The proton pump inhibitors are the drugs of choice for the treatment of disease. Since, in most cases, the disease is long, most patients should receive these drugs over time.

The above text was prepared by Dr.. Paul A. Antoniou, who is a Gastroenterologist - Hepatologist and works in private hospital "Hippocration", which adopted the text in printed form.