Potential Causes And Treatments For Gastroesophageal Reflux Disease

Potential Causes And Treatments For Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a digestive disorder
that affects the lower esophageal sphincter (LES)--the muscle
connecting the esophagus with the stomach. Many people, including
pregnant women, suffer from heartburn or acid indigestion caused by
GERD. Doctors believe that some people suffer from GERD due to a
condition called hiatal hernia. In most cases, heartburn can be
relieved through diet and lifestyle changes; however, some people may
require medication or surgery.

Gastroesophageal refers to the stomach and esophagus. Reflux means
to flow back or return. Therefore, gastroesophageal reflux is the
return of the stomach's contents back up into the esophagus.

In normal digestion, the LES opens to allow food to pass into the
stomach and closes to prevent food and acidic stomach juices from
flowing back into the esophagus. Gastroesophageal reflux occurs when
the LES is weak or relaxes inappropriately allowing the stomach's
contents to flow up into the esophagus.

The severity of GERD depends on LES dysfunction as well as the type
and amount of fluid brought up from the stomach and the neutralizing
effect of saliva.

Some doctors believe a hiatal hernia may weaken the LES and cause
reflux. Hiatal hernia occurs when the upper part of the stomach moves
up into the chest through a small opening in the diaphragm
(diaphragmatic hiatus). The diaphragm is the muscle separating the
stomach from the chest. Recent studies show that the opening in the
diaphragm acts as an additional sphincter around the lower end of the
esophagus. Studies also show that hiatal hernia results in retention of
acid and other contents above this opening. These substances can reflux
easily into the esophagus.

Coughing, vomiting, straining, or sudden physical exertion can cause
increased pressure in the abdomen resulting in hiatal hernia. Obesity
and pregnancy also contribute to this condition. Many otherwise healthy
people age 50 and over have a small hiatal hernia. Although considered
a condition of middle age, hiatal hernias affect people of all ages.

Hiatal hernias usually do not require treatment. However, treatment
may be necessary if the hernia is in danger of becoming strangulated
(twisted in a way that cuts off blood supply, i.e., paraesophageal
hernia) or is complicated by severe GERD or esophagitis (inflammation
of the esophagus). The doctor may perform surgery to reduce the size of
the hernia or to prevent strangulation.

Dietary and lifestyle choices may contribute to GERD. Certain foods
and beverages, including chocolate, peppermint, fried or fatty foods,
coffee, or alcoholic beverages, may weaken the LES causing reflux and
heartburn. Studies show that cigarette smoking relaxes the LES. Obesity
and pregnancy can also cause GERD.

Heartburn, also called acid indigestion, is the most common symptom
of GERD and usually feels like a burning chest pain beginning behind
the breastbone and moving upward to the neck and throat. Many people
say it feels like food is coming back into the mouth leaving an acid or
bitter taste.

The burning, pressure, or pain of heartburn can last as long as 2
hours and is often worse after eating. Lying down or bending over can
also result in heartburn. Many people obtain relief by standing upright
or by taking an antacid that clears acid out of the esophagus.

Heartburn pain can be mistaken for the pain associated with heart
disease or a heart attack, but there are differences. Exercise may
aggravate pain resulting from heart disease, and rest may relieve the
pain. Heartburn pain is less likely to be associated with physical
activity.

More than 60 million American adults experience Gerd and heartburn
at least once a month, and about 25 million adults suffer daily from
heartburn. Twenty-five percent of pregnant women experience daily
heartburn, and more than 50 percent have occasional distress. Recent
studies show that GERD in infants and children is more common than
previously recognized and may produce recurrent vomiting, coughing and
other respiratory problems, or failure to thrive.

Doctors recommend lifestyle and dietary changes for most people with
GERD. Treatment aims at decreasing the amount of reflux or reducing
damage to the lining of the esophagus from refluxed materials.

Avoiding foods and beverages that can weaken the LES is recommended.
These foods include chocolate, peppermint, fatty foods, coffee, and
alcoholic beverages. Foods and beverages that can irritate a damaged
esophageal lining, such as citrus fruits and juices, tomato products,
and pepper, should also be avoided.

Decreasing the size of portions at mealtime may also help control
symptoms. Eating meals at least 2 to 3 hours before bedtime may lessen
reflux by allowing the acid in the stomach to decrease and the stomach
to empty partially. In addition, being overweight often worsens
symptoms. Many overweight people find relief when they lose weight.

Cigarette smoking weakens the LES. Therefore, stopping smoking is important to reduce GERD symptoms.

Elevating the head of the bed on 6-inch blocks or sleeping on a
specially designed wedge reduces heartburn by allowing gravity to
minimize reflux of stomach contents into the esophagus.

Antacids taken regularly can neutralize acid in the esophagus and
stomach and stop heartburn. Many people find that nonprescription
antacids provide temporary or partial relief. An antacid combined with
a foaming agent such as alginic acid helps some people. These compounds
are believed to form a foam barrier on top of the stomach that prevents
acid reflux from occuring.

Long-term use of antacids, however, can result in side effects,
including diarrhea, altered calcium metabolism (a change in the way the
body breaks down and uses calcium), and buildup of magnesium in the
body. Too much magnesium can be serious for patients with kidney
disease. If antacids are needed for more than 3 weeks, a doctor should
be consulted.

For chronic reflux and heartburn, the doctor may prescribe
medications to reduce acid in the stomach. These medicines include H2
blockers, which inhibit acid secretion in the stomach. Currently, four
H2 blockers are available: cimetidine, famotidine, nizatidine, and
ranitidine.

Sometimes GERD results in serious complications. Esophagitis can
occur as a result of too much stomach acid in the esophagus.
Esophagitis may cause esophageal bleeding or ulcers. In addition, a
narrowing or stricture of the esophagus may occur from chronic
scarring. Some people develop a condition known as Barrett's esophagus,
which is severe damage to the skin-like lining of the esophagus.
Doctors believe this condition may be a precursor to esophageal cancer.

Although GERD can limit daily activities and productivity, it is
rarely life-threatening. With an understanding of the causes and proper
treatment most people will find relief.