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Gastroesophageal Reflux Disease (GERD); Gastroesophageal Reflux Disease (GERD).

Gastroesophageal reflux disease (GERD) is the abnormal backflow of stomach acid up into the esophagus, the long, muscular tube that connects the back of the mouth to the stomach. Acid refluxing occurs when the sphincter between the esophagus and the stomach, the lower esophageal sphincter, doesn't work properly or when a hiatal hernia has developed (when part of the stomach protrudes up through the diaphragm-the muscular layer between the abdomen and the chest) and into the chest. Acid refluxing may also happen when a person eats food or drinks beverages that relax the lower esophageal sphincter, which allows fluid to travel backwards from the stomach to the esophagus.

The most common symptom people with GERD suffer is heartburn. Heartburn is pain or discomfort, sometimes described as burning, which rises from the stomach up into the chest. Almost everyone may experience heartburn at some time in his or her life, but recurrent or persistent heartburn is the hallmark of GERD for most people Approximately five to seven percent of the U.S. population including men, women and children have daily GERD symptoms. And almost one in five people experience heartburn or acid reflux at least once a week. It is common for those affected by symptoms to wait years before seeking treatment. In contrast to people who experience occasional heartburn, GERD patients have heartburn at least once per a week over the course of several months. The discomfort improves with antacids, wakes them up at night and travels to the neck. This definition may vary, however, by health care professional. Although persistent heartburn is the most common symptom of GERD, other symptoms include:

* a sour or bitter liquid coming into in the mouth (also known as "regurgitation" or "water brash")

* difficulty swallowing or painful swallowing, especially with dry bread or poorly chewed food

* chest pain, which may be confused with the pain of a heart attack

* throat problems, such as laryngitis, sore throat, feeling of fullness in the throat, choking at night and altered voice

* lung problems, which might include wheezing, frequent pneumonia, damaged airways or chronic asthma.

* infants with GERD may fail to gain weight or develop more slowly or they may have recurrent respiratory problems

Understanding the causes of GERD is helped by understanding the normal protective mechanisms involved in preventing acid from refluxing into the esophagus. The lower esophageal sphincter must have sufficient length below the diaphragm and muscle tone to prevent the backwash of acid into the esophagus. The normal sphincter also must have normal episodes of relaxation, which does allow ingested air to be eliminated (i.e. belching). A healthy esophagus should also be able to "clear" the acid by regular contractions and by neutralizing the acid with alkaline saliva. Additionally, the stomach must empty properly. If any of these mechanisms is altered or abnormal, then acid can wash back up into the esophagus and cause heartburn or other symptoms.

Anything that increases the pressure on the stomach can contribute to GERD by overcoming the lower esophageal sphincter. However, certain other factors also can trigger GERD. For example, smoking causes the lower esophageal sphincter to relax allowing stomach contents to wash back up into the esophagus, triggering GERD symptoms. Drinking alcohol and certain medications can also trigger symptoms. Hiatal hernia and a rare rheumatologic condition called scleroderma also increase your risk for developing GERD.

Almost one-half of all pregnant women suffer from acid reflux disease. The symptoms typically worsen in the third trimester when the enlarged uterus pushes up on the stomach. Hormones during pregnancy also cause the digestive system to work more slowly and for the lower esophageal sphincter to relax more often. Symptoms typically disappear after the pregnancy is completed.

GERD isn't always a benign disease. Untreated, chronic GERD can result in damage to the esophagus due to acid. This damage can include inflammation, ulcers, bleeding, and scarring of the esophageal tissues. Advanced or serious conditions caused by GERD include the following:

* Esophagitis. This condition is severe inflammation of the lining of the esophagus. This is also known as erosive esophagitis. Approximately 50 percent of patients with weekly reflux symptoms have esophagitis at the time of endoscopy. An endoscope is a flexible tube that has a light on it, which allows physicians to view internal sections of the body during procedures referred to as "endoscopy" or "endoscopic procedures." (see below). The severity of reflux symptoms does not correlate with the degree of inflammation.

* Esophageal ulcers. These are crater-like sores in the lining of the esophagus, which can bleed and cause anemia, or low red blood cell counts.

* Esophageal strictures. A stricture is the narrowing of the esophagus caused by scar tissue, which can lead to difficulty swallowing and recurrent episodes of food being caught in the esophagus.

* Barrett's esophagus. This is a condition where the normal lining of the esophagus is replaced by abnormal cells. Approximately 3.5 to seven percent of the patients with GERD will develop Barrett's esophagus. It is most commonly found in Caucasian men over the age of 50. Patients with Barrett's have been shown to have an increased risk of esophageal cancer.

* Respiratory complications. Theoretically, these complications occur when stomach contents wash back up the esophagus and spill into the trachea and down into the lungs or when stomach contents traveling into the esophagus cause a bronchial reflex that may lead to wheezing or may mimic asthma or cause infections like pneumonia.

* Reflux laryngitis. Inflammation of the voice box occurs when stomach acid spills into the trachea and irritates the vocal cords.

* Dental erosions. Severe GERD can lead to an increased risk of tooth decay due to stomach acids wearing away the tooth enamel.

* Reflux dyspareunia. This is a condition when heartburn symptoms occur during sexual intercourse while in the recumbent position.

* Increased risk of cancer of the esophagus. People with severe and long-standing GERD have an increased risk of esophageal cancer (i.e., adenocarcinoma of the esophagus), even when they don't develop Barrett's esophagus.

There are several diseases and conditions that present with similar symptoms and should be considered during an assessment. These include esophageal spasms, esophageal cancer, gall bladder attacks, peptic ulcer disease, gastritis, asthma and coronary artery disease.

There is an association between adult-onset asthma and GERD, especially in those with wheezing that is worse at night, when supine, or after meals, and in those with no previous history of allergies. The typical symptoms of heartburn and acid regurgitation can be absent in patients with GERD-related asthma. It is estimated that approximately 30 percent of adult asthmatics have GERD but good prospective studies are still in progress. Studies have revealed that by treating the reflux in these patients there is an improvement in their respiratory symptoms and a decrease need for asthma medications.

One of the most concerning symptoms and conditions that might be confused with GERD is chest pain due to heart disease. The question arises: Is it heartburn or heart attack? The pain can be so similar that it is often difficult to distinguish between the two without sophisticated testing. There are some differences between the two types of pain that sometimes helps in determining which is which. The classic description of cardiac chest pain is crushing, heavy or dull pain below the sternum (chest bone) that may extend up to the neck, shoulders or arms. The pain is usually helped by nitroglycerin, and shortness of breath is commonly present. The chest pain with GERD typically is burning or sharp, just below the ribs, and it may extend upwards. Pain usually occurs after meals and is often relieved by antacids. NOTE: The symptoms of chest pain that accompany a heart attack are notoriously inconsistent with the classic description, especially in women, who often present with atypical pain, such as abdominal pain or back pain. If pain lasts for more than few minutes do not try to diagnose yourself, but seek immediate medical attention.

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Editorial Staff of the National Women's Health Resource Center 2002/12/01 2005/03/16 Gastroesophageal reflux disease (GERD) is the abnormal backflow of stomach acid up into the esophagus, the long, muscular tube that connects the back of the mouth to the stomach. Acid Laryngitis,acid regurgitation,Barrett's esophagus,Esophageal strictures,Esophagitis,Gastroesophageal reflux disease,GERD,Reflux dyspareunia
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Publication:NWHRC Health Center - Gastroesophageal Reflux Disease
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Date:Mar 16, 2005
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