All about Gastroesophageal Reflux Disease

Acid reflux is scientifically known as GastroEsophageal Reflux Disease (GERD). It is a disease characterized by the abnormal reflux of gastric contents into the esophagus resulting to chronic symptoms or mucosal damage.

Gastroesophageal Reflux Disease Acid RefluxAcid reflux is often caused by temporary or permanent alterations in the lining that separates the esophagus and the stomach. Ineffectiveness of the lower esophageal sphincter (LES) or a temporary LES relaxation connected with a hiatal hernia are just some of the common causes of acid reflux. The process can also lead to a backflow of gastric juices to the pharynx or mouth.

Among adults, the most common symptom of Gastroesophageal Reflux Disease is heartburn which is caused by the presence of acid in the esophagus. Heartburn is characterized by a painful burning sensation behind the sternum or breastbone. Another symptom or manifestation of gastroesophageal reflux disease is esophagitis which is characterized by an inflammation of the lining of the esophagus which is also known as the mucosal lining. Esophagitis also causes swallowing difficulties and chronic pains in the chest area.

Sometimes, individuals suffering from acid reflux may also experience coughing, persistent pain in the ears, hoarseness or a change in the voice and even sinusitis. If acid reflux gets complicated it may lead to formation of a stricture or ulcers in the esophagus. It may also lead to a condition called Barrett’s esophagus and in worst cases, to cancer of the esophagus.

It doesn’t mean however that a person who regularly suffers from heartburn is suffering from acid reflux. By all means, the heartburn may be from other causes. But if a person suffers from heartburn for more than once a week, then he or she is at a risk of acquiring acid reflux. Persons with hiatal hernia are also at a greater risk of developing acid reflux than those who are not.

The pain felt by persons suffering from heartburn is caused by the reflux of acid contents from the stomach to the esophagus. A pain in the chest area coming upwards the mouth.

Persons suffering from acid reflux may also experience tasting something sour or salty behind her throat. This is cause by regurgitation. This sour and salty taste may persist even without heartburn,

Other less common symptoms of acid reflux include difficulty swallowing, chest pain, halitosis or bad breath, repeated throat clearing and water brash or hypersecretion of saliva.

The symptoms of gastroesophageal reflux disease (acid reflux) in children are also the same as that on adults. Acid reflux in children may manifest in frequent spitting, throwing up repeatedly, coughing and other respiratory problems. Children suffering from acid reflux may also experience weight loss, frequent crying, loss of appetite and bad breath. Parents must remember though that children may show one or many symptoms. There is not one symptom that is always present in children with acid reflux.

The Gastroesophageal Reflux Disease causes in children, especially in babies is their immature digestive system. This is why infants stop having acid reflux when they reach the first year of age. However, some children do not outgrow acid reflux. Some continue to suffer from the disease up to the teen years.

The best thing to do for parents of children suffering from acid reflux is to take the children to the doctor as soon as possible to avoid any complications.

Gastroesophageal Reflux Disease Causes

Acid reflux or GERD (gastroesophageal reflux disease) occurs when the liquid that is in the stomach backs up into the esophagus. This is usually a condition which persists throughout the life of the individual. Because the acid backs up into the esophagus, the esophagus may be damaged.

Acid reflux (GERD) can have many causes. The action of the lower esophageal sphincter (LES) may be one cause. The esophagus connects to the stomach. There is a muscle ring that goes around the end of the esophagus at the point where it meets the stomach. This is the LES. When we eat or drink the LES allows the food to pass into the stomach and then the muscle ring closes so the food does not reflux. People with acid reflux (GERD) may have abnormalities with their LES. The LES may have a weak contraction so there is a very good chance of reflux. Or, the LES may be too relaxed. The longer the LES is open (relaxed) reflux can easily occur.

Another cause of gastroesophageal reflux disease (GERD) is a hiatal hernia. Some people with acid reflux have hiatal hernias and some do not. Hiatal hernias are not a pre-requisite for acid reflux, but a large amount of people with acid reflux DO have hiatal hernias. A hiatal hernia disrupts the location of the LES. The LES should be on a level with the diaphragm but due to the hiatal hernia the LES is pushed up and lies in the chest. This is a problem because the diaphragm is a large part of helping the LES to prevent reflux. Now the pressure of both the LES and diaphragm are not working as a strong unit. The hiatal hernia contributes to the reflux because of the decreased pressure.

Gastroesophageal Reflux Disease can also be caused by a hiatal hernia due to the hernial sac. The location of the sac is near the esophagus. Acid gets trapped in the sac. Because the sac is so close to the esophagus, when the LES relaxes, it is easy to reflux.

The hiatal hernia can lead to acid reflux in a third way. Normally the esophagus connects to the stomach at an angle creating a flap of tissue. The hiatal hernia leads to the flap becoming warped and therefore it is useless to stop reflux.

People with acid reflux have a problem with the contraction of the esophageal muscles when they swallow. This is an issue because the contraction pushes all of the items in the esophagus into the stomach. If there is not a good contraction then the acid does not get pushed back and remains in the esophagus. Smoking disturbs the clearing of the esophagus too. It takes about six hours from the last cigarette you smoke for the effect on the esophagus to wear off.

Acid reflux is most common after meals. It is always better to be vertical so gravity can help the acid move down into the stomach. Large meals are not recommended for people with acid reflux.

There are many different reasons people may have acid reflux. Learning the cause may help in your quest to relieve some of the discomfort of acid reflux.

How to Recognize the Symptoms of Acid Reflux

Acid reflux (gastroesophageal reflux disease) is a physiological condition that causes the content of the stomach to reflux into the esophagus and throat. Although there are many factors that contribute to the development of acid reflux, the main cause is inappropriate activity of the lower esophageal sphincter (muscular valve that seals the lower ending of the esophagus), allowing the stomach acids to reach the upper levels of the body. Additional causes of acid reflux are inappropriate diet, unhealthy lifestyle or other physical dysfunctions and conditions.

Acid reflux can become serious if it is not appropriately treated. The symptoms of acid reflux should be spotted quickly, in order to prevent the development of complications (esophageal inflammation and lesions, damage of the throat, gastro-intestinal disorders, breathing problems). The symptoms of acid reflux are easy to identify and it is best to see a physician as soon as they occur. The condition has a chronic character and usually requires ongoing treatment. For some patients, surgery is best alternative in overcoming acid reflux. But there are other gastroesophageal reflux disease treatment options available, consult gastroenterologist.

Acid reflux is very common in infants and young children. Although for most babies the symptoms of acid reflux disappear with time, in some cases the condition can persist for years, causing serious harm to the gastro-intestinal system and the esophagus. The most common symptoms of acid reflux in infants are: spitting, vomiting, coughing, irritability, discomfort when feeding and the presence of blood in feces. Other symptoms of acid reflux in babies occur if the condition is severe: pronounced difficulty swallowing, intense pain when feeding, spitting or coughing blood, vomiting blood, presence of blood in stools, problems with breathing.

Common symptoms of acid reflux in adults are: abdominal pain and discomfort (especially after meals), bad breath, bitter taste in the mouth, excessive secretion of saliva, and sleeping problems. People with acid reflux can also develop apnea, a sleeping disorder manifested through respiratory insufficiency.

The extended symptoms of acid reflux in adults are: difficulty swallowing, chest burn and aching, poor appetite, nausea, presence of blood in vomit and stools, throat inflammation and pain, breathing difficulties. If the symptoms of acid reflux become very intense it is a clear sign of aggravation. Acid reflux can cause serious damage at the level of the esophagus, due to its constant exposure to stomach gastric acid. Acid reflux can cause inflammation, swelling and even scarring of the esophageal soft tissue. It is very important to pay attention to the symptoms of acid reflux, and act quickly in overcoming the condition. If acid reflux occurs frequently, it can cause serious complications.

Top 6 Gastroesophageal Reflux Disease Symptoms

Acid reflux disease is a condition in which the stomach acids abnormally reflux into the esophagus. This phenomenon is irregularly experienced by most people, most especially after eating.

Our body uses gastric and stomach acids to break down the food that we eat. Normally, after the digestion in the stomach, the food is delivered by the digestive muscles to the intestines for extra digestion. But in patients who have acid reflux disease, the acidic stomach contents are moved back to the esophagus, which then causes inflammation. Cigarettes, alcohol, caffeine, pregnancy, and fatty foods are some factors which worsens acid reflux conditions.

Our present knowledge about acid reflux based on medical researches tells us that this disease is common in men as it is in women. There is no sexual preference. Moreover, the prevalence of acid reflux is more frequent in people of 40 years of age or more.

Gastroesophageal reflux disease symptoms may be typical or atypical. But based on the diagnosis of acid reflux patients, only 70% of those who have this disease manifest typical symptoms.

Typical or esophageal symptoms concern indicators which are related with the esophagus. Such symptoms include the following:

  1. Heartburn: This is a condition in which the patient feels a painful burning feeling in the esophagus. The pain often develops in the chest and may swell to the neck or throat. This is most probable to occur in relation with these activities: after a heavy meal, lifting, bending over, and lying down. Based on one study, about 75% of acid reflux patients experience this symptom at night. These nigh-time patients also tend to experience more harsh pain than those whose symptom occurs at other times.
  2. Dyspepsia: Researches show that about half of acid reflux patients have dyspepsia. This is a syndrome which consists of pain and distress in the upper abdomen, nausea after a meal, and stomach fullness. It is not a rule however, that those who have dyspepsia have acid reflux.
  3. Regurgitation: This is when the gastric contents back up into the pharynx and sometimes as far as the mouth. In cases where the acids have spilled into the tracheobronchial tree, respiratory complications can be stimulated.
  4. Throat Symptoms: Although it does not commonly happen, acid reflux patients suffer from symptoms that occur in the throat. Hoarseness, the feeling of having a lump in the throat, dry cough are undergone by those who have acid laryngitis, a throat symptom. Patients can also have difficulty in swallowing, a condition known as dysphagia. In critical cases, the food may get trapped in the throat or even choke, which can result to a severe chest pain. Other throat symptoms are chronic sore throat and persistent hiccups.
  5. Vomiting and Nausea: When a patient suffers from nausea which persists for weeks, he may have acid reflux. There are few instances where vomiting can occur as often as once a day.
  6. Respiratory Symptoms: Coughing and wheezing are counted as respiratory symptoms. These result from the overrunning of the stomach acids into the tracheobronchial tree creating bronchoconstriction.

Gastroesophageal reflux disease can last for several months if not given proper medical attention. Drug treatment may only be required for a short time. But when the symptoms tend to repetitively occur, the drug treatment may have to be reapplied.

Gastroesophageal Reflux Disease Treatment Option

To diagnose Acid Reflux, one can go through gastroscopy, since the symptoms of this disease re so mild that diagnosing them is very difficult and people rather than going to the doctor stick to own medication. The very commonly used resort to escape the pains and the problems from GERD is going for an antacid. These are actually helpful in case of short-term and infrequent attacks of the disease. But these can’t provide much relief for a long time.

People can change their gastroesophageal reflux disease diets to actually eliminate or reduce the effects of Acid Reflux. A proper routine can be made to reduce the problem which generally causes due to the irregular habits of eating or eating more junk food and also from excessive drinking. Patients also in this case maintain diaries for keeping a track of what they eating and drinking to keep a check on the recurrence of the attacks of Acid Reflux. And when these controlled diets also don’t help in controlling the disease then the doctors resorts to drugs to keep the disease in a controlled position.

Gastroesophageal Reflux Disease – Most Used Drugs

The most popular and largely used drug for this disease is PPI (Proton Pump Inhibitors), this is the drug which is generally prescribed by the doctors for relief from the pains causing due to the attacks of Acid Reflux. The drug helps in stopping the production of the acidic contents in the stomach which pushes into esophagus and cause acid reflux. Not many side effects do these drugs have, but are really relieving at times of attacks.

The other drug primarily prescribed by the doctors all over the world is 2 Blocker, which also restores relief to the esophagus. Both these drugs have been proved to be successful drug therapy for long term acid reflux sufferers. But patients with more severe damages, who don’t respond to these drugs, are prescribed more radical drugs, with strong effects, known as Promotility agents. These drugs have sometimes adverse side effects, so these are very seldom prescribed by the doctors.

Gastroesophageal Reflux Disease – Lifestyle Modifications

  • Avoid soft drinks that contain caffeine. Other foods to avoid are chocolate, peppermint, spicy foods, acidic foods like oranges, canned tomatoes, onions, cabbage, cauliflower, broccoli, Brussels and sprouts.
  • Milk and milk-based products contain calcium and fat, so should be avoided before bedtime.
  • Avoiding food for 2 hours before bedtime and not lying down after a meal are frequently recommended lifestyle modifications.
  • Elevation to the head of the bed is the next-easiest to implement. Products are also available as seen on tv that will elevate the head of your bed through the use of an inflatable mattress lifter. This is an ideal low cost solution for relief from acid reflux.
  • You can also accomplish the correct elevation by placing cinder blocks as noted above or with other items: plastic or wooden bed risers which support bed posts or legs, a bed wedge pillow.

The height of the elevation is critical and must be within the range of 6 to 8 inches in order to be as effective as possible in hindering the backflow of gastric fluids. Elevating the bed is also known as “positional therapy”.

Gastroesophageal Reflux Disease – Drug Treatments

A number of drugs are registered for the treatment of acid reflux, and they are among the most-often-prescribed forms of medication in most Western countries. They can be used in combination with other drugs, although some antacids can impede the function of other medications.

  • Antacids before meals or symptomatically after symptoms begin can increase the pH and reduce gastric acidity. Alginic acid may coat the mucosa as well as increase the pH and decrease reflux.
  • Gastric H2 receptor blockers such as ranitidine or famotidine can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all acid reflux patients.
  • Proton pump inhibitors such as omeprazole are the most effective in reducing gastric acid secretion, as they stop the secretion of acid at the source of acid production, i.e. the proton pump.

To maximize effectiveness of this medication the drug should be taken a half hour before meals. Prokinetics strengthen the lower esophageal sphincter and speed up gastric emptying. Cisapride, a member of this class, was withdrawn from the market for causing Long QT syndrome.

If one implements pharmacologic therapy in combination with food avoidance before bedtime and elevation of the head of the bed over 95% of patients will have complete relief.

Gastroesophageal Reflux Disease – Surgical Treatment

The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication. The upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done laparoscopically.

An obsolete treatment is vagotomy, the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication.

Gastroesophageal Reflux Disease Diet

It seems that one of the major culprits causing acid reflux is alcohol. Not good news for the drinkers amongst us. Take heart though, it is probably only excessive drinking that’s to blame – perceived wisdom is that a couple of glasses of wine with your dinner won’t hurt you, although there is some argument as to whether red or white is better. Personally, I find white wine more acidic and therefore assumed that it would be more likely to cause gastroesophageal reflux disease. However, as alcohol prevents the oesophageal sphincter from working properly and thus allows stomach acid to reflux into the oesophagus, the acidity of the alcohol may be irrelevant. Notwithstanding that, when drinking alcohol, limit quantities and dilute spirits with water or a mixer. Wine may also be diluted with water or lemonade. Gassy drinks like champagne and beer should be avoided if possible.

Alcohol is not the only culprit – chocolate, peppermint, coffee, tea, caffeinated soft drinks such as colas and citrus fruit juices also inhibit the normal workings of the oesophageal sphincter so keep intake of these to an absolute minimum, if you can’t give them up completely.

Chewing gum and eating hard sweets cause excessive air to be swallowed, thus causing wind and reflux.

Fatty and fried foods also delay the emptying of the stomach so steer clear of any fatty meat, particularly those found on the delicatessen counter, such as salamis, sausages and patés. “Fatty” includes full fat milk and other dairy products (cheese, cream, butter, margarine). Tomatoes can aggravate the condition in some people, as can spices such as chillies (powdered, fresh or dried) and any derivatives like Tabasco. Condiments such as Worcestershire and soy sauces and any sort of horseradish or mustard should also be taken with care.

Now for the good news – you can eat, with some freedom, vegetables (not tomatoes), chicken and turkey (without skin), fish, apples, peaches, melons, pears and berries. You can eat, in moderation, skimmed or semi-skimmed milk, low fat spreads and cottage cheese. Oh, and you can drink water until you float!

A few other things you can do to gerd foods to avoid or alleviate acid reflux are:

  • Avoid eating large meals – little and often is better.
  • Avoid eating too late at night.
  • Don’t lie down or bend over when you’ve just eaten a meal.
  • Put blocks of wood under the head of the bed to raise it by six inches or so.
  • Try not to wear tight clothing around the area of the abdomen and stomach.
  • Nicotine weakens the lower oesophageal muscle – give it up – it’s not good for you anyway!
  • Lose weight if you need to. Obesity is not only usually caused by eating all the foods that you should be avoiding, but leads to worsened acid reflux.

Ultimately, everyone is different and foods that some people can tolerate cause incredibly painful indigestion for others. Only you can tell, so be sensible and avoid those foods that have an adverse effect.

Disclaimer

The information presented here should not be interpreted as medical advice. If you or someone you know suffers from acid reflux, please seek professional medical advice for the latest treatment options.

All about Gastroesophageal Reflux Disease
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