Gastroesophageal Reflux Disease – Very Common But Not So Innocent

Danger Level: Medium 

What is it?

Gastroesophageal Reflux Disease, or GERD for short, is a condition in which acid from the stomach goes up to the esophagus.

Who gets it?

GERD is a pretty common condition. Up to 15% of the population have its symptoms at least once a week.

What causes it?

The esophagus (1 in the drawing below) is a sort of tube leading the food we swallow down to the stomach(3 in the drawing). After food gets into the stomach, there’s a one way barrier, called a sphincter, which prevents the food from going back up again to the esophagus.

gerd-esophagus

That sphincter is called the lower esophageal sphincter, or LES for short. (You can understand from this that there’s also an upper one: it’s between the esophagus and the mouth and closes down after we swallow food).

In GERD there is a problem with the LES – it can’t stay closed tightly enough to prevent food from going back up. It can be due to many reasons, such as pregnancy or obesity (which cause extra pressure in the stomach), hernias, certain medications, smoking, muscle weakness, and other conditions.

How does it feel?

The acid going up from the stomach causes heartburn, or a feeling of burning in the chest (sometimes confused with a heart attack). Other things it can cause:

1. Persistent cough

2. Inflammation of the throat

3. Pneumonia

4. Hoarseness

How is it discovered?

Usually no special tests are needed – the symptoms above are often quite enough to know it’s GERD. Sometimes, though, more tests are needed:

1. Barium swallow: Barium is a material you swallow before an x-ray picture of your esophagus (and sometimes the stomach) can be taken. That’s because these organs don’t show well enough on x-rays, since they are hollow. The barium that you swallow coats the esophagus from within like a dye, making it visible to the x-ray picture, like shown here:

gerd-Barium_swallow

That picture will show if any complications (described below) have been caused by the GERD.

2. Esophagoscopy: A procedure in which a tube with a camera at its end is inserted into the esophagus, allowing the doctor to see what’s in your esophagus. Again, this will show any complications.

One of the simplest ways to know if the condition is GERD is simply to treat it and see if the symptoms go away.

How is it treated?

The treatment includes changes in your lifestyle (such as quitting smoking, losing some weight, avoiding eating chocolate or fatty foods) as well as drugs. The most common drugs are antacids, but there are stronger drugs. Those drugs cause the stomach to release less acid, which will stop the symptoms, and they are called H2 blockers and PPI’s.

In some cases a surgery can be performed, where the edge of the stomach is wrapped around the esophagus, thus giving the area more tension and preventing acid from coming up.

What happens after treatment?

It’s very important to treat GERD because of its possible complications:

1. Esophagitis: In medicine, anything with an “itis” at its end means an inflammation. In this case, an inflammation of the esophagus.  Besides being painful, it can lead to a condition called Barrett’s esophagus – in which the lining of the esophagus changes to something more rigid in order to protect it from damage. This might sound good, but actually Barrett’s esophagus can be the start of the process of changing the lining all the way to cancer of the esophagus (this is one of the reasons the esophagoscopy above is done – to find out if this condition exists).

2. Peptic stricture: This is a narrowing of the esophagus, also caused from the continuous damage to it. The narrowing causes problems with the passage of food through the esophagus.


The bottom line – How do I avoid it?

 

 

You can avoid having GERD by following these steps:

1. Losing weight – Obese people tend to have weak sphincters, and they more often develop a condition related to GERD called hiatal hernia, in which the upper part of the stomach protrudes above the diaphragm, resulting in a deformed LES.

2. avoid lying down sooner than three hours after a meal, and elevate the head of your bed 6-8 inches - Lying down prevents gravity from keeping the stomach contents well below the opening from the esophagus.  

3. Quit smoking and excessive alcohol. Try to avoid foods such as fatty food, drinks that contain caffeine and  chocolate.

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Posted in Esophagus
 

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