Reflux Disease

Disease definition:
Gastroesophageal reflux disease (GERD) is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. The esophagus is the tube extending from the throat all the way to the stomach. When food is swallowed, it travels down the esophagus and enters into the stomach. Once in the stomach, the food is digested. The stomach produces an acid called hydrochloric acid, which is highly acidic (pH of around 1.5 to 3.5),to aid in the process of digestion. To prevent hydrochloric acid from entering the esophagus, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, closes to prevent reflux (or backing up) of acid.

Recent studies have shown that GERD affects approximately 25% to 40% of the adult population in the United States. About 10% of adults actually experience GERD on a daily or weekly basis. Adults are not the only ones affected by this disease. Research has shown that by the time infants are 3 months old, more than 50% of them will suffer from GERD.



Causes:
GERD can be caused by many different circumstances. Some of these various conditions include abnormal biological or structural factors. When individuals suffer from frequent heartburn it is extremely important for them to consult a physician to find the actual cause of their acid reflux.
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List of common causes of GERD:
  • Malfunction of the Lower Esophageal Sphincter (LES) Muscle
    • The band of muscle located between the esophagus and the stomach is called the lower esophageal sphincter (LES). This muscle is responsible for closing and opening the lower end of the esophagus. It also can act as a barrier against the contents in the stomach. If the LES is weakened or loses tone, it loses its ability to close completely after food passes into the stomach. Stomach acid can then back up into the esophagus. Multiple factors can weaken the LES. Factors include the following: highly acidic foods, carbonated beverages, drugs, and nervous system factors.
  • Impaired Stomach Function
    • Over half of GERD patients have shown abnormal nerve or muscle function in their stomachs. These abnormalities cause impaired motility, which in turn causes muscles in the stomach to lose its ability to act spontaneously. Since these muscles are not able to contract normally, emptying of the stomach is delayed. As a result of delayed emptying, pressure in the stomach increases, which can increase the risk for stomach acid to back up into the esophagus.
  • Hiatal Hernia
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    • A hiatal hernia can also be a unique cause of GERD. A hiatal hernia occurs when the fundus of the stomach pushes through the opening of the diaphragm called the esophageal hiatus. Having the stomach pushed through the esophageal hiatus can weaken the LES and cause reflux.
  • Asthma
    • Physicians believe that the coughing associated with asthma attacks can lead to pressure changes in the chest, which in turn, could trigger a reflux. In addition, certain drugs to treat asthma mainly dilate the airways, but can also relax the LES and contribute to GERD.
  • NSAIDs
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) have shown to cause GERD and increase the symptoms and severity of GERD.
    • NSAIDs include:
      • Aspirin
      • Ibuprofen (Motrin, Advil, Nuprin, Rufen)
      • Naproxen (Aleve)



Symptoms and Signs:
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GERD signs and symptoms include:
  • A burning sensation in your chest (heartburn), which can spread to the throat, accompanied by a sour taste in the mouth
  • Chest pain
  • Difficulty swallowing (dysphagia)
  • Dry cough
  • Hoarseness or sore throat
  • Regurgitation
  • Sensation of a lump in the throat

Conditions that can increase your risk of GERD include:
  • Obesity
  • Hiatal hernia
  • Pregnancy
  • Smoking
  • Dry mouth
  • Asthma
  • Diabetes
  • Delayed stomach emptying
  • Connective tissue disorders, such as scleroderma

Medical Treatments: 1330977043478.png
Medications have been known to help suppress the symptoms of GERD. The first popular medication used is antacids such as Tums and Mylanta. These drgs neutralize the acid in the stomach. The second medication used are H2 blockers such as Cimetidine (Tagamet) and Famotidine (Pepcid). These medications actually reduce the production of acid in the stomach. Finally, there are proton pump inhibitors such as lansoprazole (Prevacid) and omeprazole (Prilosec), which also reduce the production of acid.

Dietary Treatments:
Modifying eating behaviors and making lifestyle changes have also shown to be beneficial in managing and preventing GERD. It has been shown that the following lifestyle changes have been the most beneficial:
  • Weight loss
  • Avoiding Alcohol
  • Quitting smoking

In addition, avoiding trigger foods may help. Trigger foods tend to be acidic and thus decrease the pH in the stomach (increases the amount of acid) and will contribute to the prevalence of GERD. The most common foods that trigger GERD symptoms are:
  • Alcohol
  • Chocolate
  • Carbonated beverages
  • Fatty foods
  • Spicy foods
  • Citrus fruits and juices
  • Caffeine
  • Mint
  • Tomatoes and foods made with tomatoes

Other options to reduce the prevalence of GERD and it's symptoms are:
  • Eating smaller meals
  • Eating slowly
  • Not lying down immediately after eating
  • Wearing loose clothing
  • Sleeping on an incline
  • Reviewing medications with your physician.

References:
http://heartburn.about.com/od/gerdacidrefluxdisease/a/gerdcauses.htm
http://www.emedicinehealth.com/acid_reflux_disease_gerd/article_em.htm#Reflux%20Disease%20%28GERD%29%20Causes
http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=symptoms
http://www.webmd.com/heartburn-gerd/tc/gastroesophageal-reflux-disease-gerd-medications
http://www.everydayhealth.com/gerd/managing/self-help-for-reflux.aspx
Mahan, L.K. and Stump, S.E. Krause's Food and Nutrition Therapy. (2008). Canada: Saunders Elsevier. p. 655 - 660
Yarrow, L. Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders. Clinical Nutrition II. February 24, 2012.