The next
few days I will be blogging about GERD
(Reflux Disease) and its possible connection to lung disease. Today is
the definition of GERD from the International Foundation for Functional
Gastrointestinal Disorders followed by a full explanation of GERD, possible
causes, symptoms and treatments,
from the U.S. National Library of Medicine website. Thanks to Sally, the head
of our ILD Support Group, for these sites.
About
GERD
REFLUX DISEASE HELP
GERD, or
gastroesophageal reflux disease, is a condition which develops when the
back-flow (reflux) of stomach contents causes troublesome symptoms and/or
complications. Serious health problems can result if it is not treated
properly.
Signs can
be Clear – But Easily Missed
The most frequent
symptom of GERD – heartburn – is so common that it may not be seen as part of
a disease. But repeated heartburn can be a sign of GERD.
Heartburn is not
the only symptom of GERD. Troubles swallowing, sore throat, or hoarseness in
the morning are just a few other signs. And GERD may be present even without
heartburn.
Get the
Right Treatment
GERD is generally a
treatable disease. All too often, GERD is either self-treated or mistreated.
Talking to a doctor is important to receiving proper diagnosis and treatment of
GERD.
GERD treatments
range from lifestyle or diet measures to the use of medication or
surgical procedures. If you have signs of GERD, get an accurate diagnosis,
work with your doctor, and receive the most effective treatment available.
A.D.A.M.
Medical Encyclopedia.
Gastroesophageal reflux disease
Peptic
esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia - GERD
Last
reviewed: August 11, 2011.
Gastroesophageal
reflux disease (GERD) is a condition in which the stomach contents (food or
liquid) leak backwards from the stomach into the esophagus (the tube from the
mouth to the stomach). This action can irritate the esophagus, causing
heartburn and other symptoms.
Causes, incidence, and risk factors
When
you eat, food passes from the throat to the stomach through the esophagus (also
called the food pipe or swallowing tube). Once food is in the stomach, a ring
of muscle fibers prevents food from moving backward into the esophagus. These
muscle fibers are called the lower esophageal sphincter, or LES.
If
this sphincter muscle doesn't close well, food, liquid, and stomach acid can
leak back into the esophagus. This is called reflux or gastroesophageal reflux.
Reflux may cause symptoms, or it can even damage the esophagus.
The
risk factors for reflux include:
Alcohol (possibly)
Hiatal hernia (a condition in
which part of the stomach moves above the diaphragm, which is the muscle that
separates the chest and abdominal cavities)
Obesity
Pregnancy
Smoking
Heartburn
and gastroesophageal reflux can be brought on or made worse by pregnancy and
many different medications. Such drugs include:
Anticholinergics (e.g., for
seasickness)
Beta-blockers for high blood
pressure or heart disease
Bronchodilators for asthma
Calcium channel blockers for high
blood pressure
Dopamine-active drugs for Parkinson's
disease
Progestin for abnormal menstrual
bleeding or birth control
Sedatives for insomnia or anxiety
Tricyclic antidepressants
If
you suspect that one of your medications may be causing heartburn, talk to your
doctor. Never change or stop a medication you take regularly without talking to
your doctor.
Symptoms
More
common symptoms are:
Feeling that food is stuck behind
the breastbone
Heartburn or a burning pain in the chest
(under the breastbone)
Increased by bending, stooping,
lying down, or eating
More likely or worse at night
Relieved by antacids
Nausea after eating
Less
common symptoms are:
•
Bringing
food back up (regurgitation)
•
Cough
or wheezing
•
Difficulty
swallowing
•
Hiccups
•
Sore
throat
Signs and tests
You
may not need any tests if your symptoms are not severe.
If
your symptoms are severe or they come back after you have been treated, one or
more tests may help diagnose reflux or any complications:
•
Esophagogastroduodenoscopy (EGD) is often used to find the
cause and examine the esophagus (swallowing tube) for damage. The doctor
inserts a thin tube with a camera on the end through your mouth. The tube is
then passed into your esophagus, stomach, and small intestine.
•
Continuous
esophageal pH
monitoring
A
positive stool occult
blood test may diagnose bleeding that is coming from the irritation
in the esophagus, stomach, or intestines.
Treatment
You
can make many lifestyle changes to help treat your symptoms. Avoid foods that
cause problems for you. Making changes to your routine before you go to sleep
may also help.
See
Gastroesophageal reflux - discharge for more on managing your symptoms at home.
Avoid
drugs such as aspirin,
ibuprofen
(Advil, Motrin), or naproxen
(Aleve, Naprosyn). Take acetaminophen
(Tylenol) to relieve pain. Take your medicines with plenty of water. When your
doctor gives you a new medicine, remember to ask whether it will make your
heartburn worse.
You
may use over-the-counter antacids after meals and at bedtime, although they do
not last very long. Common side effects of antacids include diarrhea or
constipation.
Other
over-the-counter and prescription drugs can treat GERD. They work more slowly
than antacids but give you longer relief. Your pharmacist, doctor, or nurse can
tell you how to take these drugs.
•
Proton
pump inhibitors (PPIs) decrease the amount of acid produced in your stomach
•
H2
blockers (antagonists) lower the amount of acid released in the stomach
Anti-reflux
operations (fundoplication
and others) may be an option for patients whose symptoms do not go away with
lifestyle changes and drugs. Heartburn and other symptoms should improve after
surgery, but you may still need to take drugs for your heartburn.
There
are also new therapies for reflux that can be performed through an endoscope (a
flexible tube passed through the mouth into the stomach).
Expectations (prognosis)
Most
people respond to lifestyle changes and medications. However, many patients
need to continue taking drugs to control their symptoms.
Complications
•
Barrett's
esophagus
(a change in the lining of the esophagus that can increase the risk of cancer)
•
Bronchospasm
(irritation and spasm of the airways due to acid)
•
Chronic
cough or hoarseness
•
Dental
problems
•
Esophageal
ulcer
•
Stricture
(a narrowing of the esophagus due to scarring)
Calling your health care provider
Call
your health care provider if symptoms worsen or do not improve with lifestyle
changes or medication.
Also
call for any of the following symptoms:
•
Bleeding
•
Choking
(coughing, shortness of breath)
•
Feeling
filled up quickly when eating
•
Frequent
vomiting
•
Hoarseness
•
Loss
of appetite
•
Trouble
swallowing (dysphagia) or pain with swallowing (odynophagia)
•
Weight
loss
Prevention
Follow
heartburn prevention techniques to prevent GERD.
References
1.
Richter
JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman
LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver
Disease. 9th ed.
Philadelphia, Pa: Saunders Elsevier; 2010:chap 43.
2.
Wang
KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and
therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-797.
3.
Kahrilas
PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American
Gastroenterological Association Medical Position Statement on the management of
gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391.
4.
Galmiche
JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs
esomeprazole treatment for chronic GERD: the LOTUS randomized controlled trial.
JAMA.
2011;305:1969-1977.
Review
Date: 8/11/2011.
Reviewed
by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser
Permanente Medical Care Program, San Diego, California. Also reviewed by
David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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