Reflux Disease 13


What is Reflux Disease?



Reflux disease is a chronic symptom of mucosal damage caused by stomach acid coming up from the stomach and into the esophagus. Common forms of reflux disease might include: Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease. GERD, the most common form of reflux disease, is usually caused by changes between the stomach and esophagus, including abnormal relaxation of the lower esophageal sphincter, which is responsible for holding the top of the stomach closed

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Gastroesophageal reflux disease (GERD), is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus. Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux (GER), is the return of acidic stomach juices, or food and fluids, back up into the esophagus.

The following video helps explain the pathophysiology of GERD:



What are the Symptoms of Reflux Disease?


For adults, the most common symptoms include:
  • heartburn
  • regurgitation
  • trouble swallowing (dysphagia)


For children, symptoms are often more difficult to detect because the cannot clearly describe the pain and feelings they are experiencing. GERD is common in infants and children. Signs and symptoms may include:
  • repeated vomiting
  • effortless spitting
  • coughing
  • respiratory problems, such as wheezing


For infants, symptoms include:
  • inconsolable crying
  • refusing food
  • failure to gain weight
  • bad breath
  • belching or burping

GERD can cause some injuries as well, which could effect the patient immensely, here are some common injuries associated with GERD:
  • Reflux esphagitis- the necrosis of the esophageal epithelium causes ulcers near the junction of the stomach and esophagus
  • Esophageal strictures- the constant narrowing of the esophagus caused by reflux-induced inflammation
  • Barrett's esophagus- intestinal metaplasia of the distal esophagus (changes in the epithelial cells from squamous to columnar)
  • Esophageal adenocarcinoma- a rare form of cancer in the esophagus




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Causes of Reflux Disease

There are several contributing factors that can increase the risk of reflux disease.

The most common causes include:
  • stomach abnormalities
  • smoking
  • pregnancy
  • consumption of certain foods

A Hiatal hernia can occur at any age. A Hiatal hermia is a condition in which a portion of the stomach protrudes through the diaphragm into the esophagus. This in turn allows acid to move into the esophagus.


Smoking causes many health problems when it comes to acid reflux by "increasing acid secretion, reducing LES muscle function, impairing muscle reflexes in the throat, damaging mucus membranes, and reduces salivation, which neutralizes the effect of acid".

Pregnancy is a risk factor primarily due to the fluctuating levels of hormones in the body. The symptoms of gastric reflux usually dissipate after delivery.

Foods that contribute to reflux disease such as soda, chocolate, citrus fruits, coffee, garlic, spicy foods with curry, tomato based foods, fried foods, and alcohol.

Other contributing factors of acid reflux disease include: overweight/obesity, exercise and eating right before sleep.


Medical Treatment


Antacids - medicine that is for short term relief and can mostly be purchased over the counter as opposed to needing a prescription. Antacids specifically reduce acids that are produced in the stomach that can cause a burning sensation. Examples include Pepto-Bismol and Tums.

Acid Pump Inhibitors- this medical treatment is specifically for reducing acid that the body produces. This is longer lasting than antacids, but initially may take longer to come in affect and notice a difference. These are used if a person has problems with acid reflux more than 2 days in a week. Examples of medicine include Prilosec and Lansoprazole.

Histamine antagonist also work in a way to reduce acid production. The effect isn't right away noticed, but within an hour a difference is noted. Examples include Zantac and Pepcid.

Surgery - this is the last resort to medical treatment when antacids, acid pump inhibitors and histamine antagonists are not as effective as need be to relieve pain of acid reflux disease.


Dietary Treatment for Reflux Disease


There are several dietary implications to consider for reflux disease.

Research has shown that certain foods and lifestyle habits can promote reflux disease. Consuming foods with a high acidic content, such as citrus fruits, certain meats, chocolate, caffeine and alcohol can cause symptoms. Certain lifestyle habits such as smoking can also increase these symptoms.

  • Antacids have been shown to increase the acidity of the stomach, which causes the acid that seeps into the esophagus to also be less acidic. While they are fast acting, they do not last long. By removing highly acidic foods from the diet, symptoms may not be as severe and antacids may not be necessary.
  • Smoking reduces lower esophageal capability, thus allowing the acid to enter the esophagus. Eliminating smoking will vastly improve the condition of reflux.
  • Research has shown that weight loss can improve conditions of reflux disease in those individuals who are overweight.


References


http://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease

http://www.webmd.com/heartburn-gerd/guide/common-causes-acid-reflux-disease

http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW023030

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002122/

http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/antacids-and-acid-reducers-otc-relief-for-heartburn-and-acid-reflux.html

http://www.google.com/imgres?q=Reflux+disease&um=1&hl=en&sa=N&rlz=1C1SKPC_enUS353US365&biw=1366&bih=653&tbm=isch&tbnid=7t2U_AxWHcZqsM:&imgrefurl=http://www.livingwithcerebralpalsy.com/reflux-disability.php&docid=TekYooFkUKyFgM&imgurl=http://www.livingwithcerebralpalsy.com/images/default315.jpg&w=460&h=300&ei=nbCeT8Ugyp7aBemZ-ekO&zoom=1&iact=hc&vpx=547&vpy=315&dur=454&hovh=129&hovw=198&tx=156&ty=111&sig=109218842951518783447&page=1&tbnh=125&tbnw=192&start=0&ndsp=19&ved=1t:429,r:8,s:0,i:86

Videos


Acid reflux disease (GERD) symptoms and treatments - Heartburn remedies
http://www.youtube.com/watch?v=qEKW7IQtfb4
http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/antacids-and-acid-reducers-otc-relief-for-heartburn-and-acid-reflux.html
http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/antacids-and-acid-reducers-otc-relief-for-heartburn-and-acid-reflux.html
http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/antacids-and-acid-reducers-otc-relief-for-heartburn-and-acid-reflux.html
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