Gastroesophageal Reflux Disorder (GERD) - a chronic condition in which gastric contents leak back from the STOMACH into the ESOPHAGUS. Because stomach juices are highly acidic, this backwash creates chemical BURNS in the delicate tissues of the esophagus. The lining of the esophagus lacks the protective mucus that safeguards the stomach from gastric acid, making it vulnerable to injury. Up to 40 percent of adults in the United States have GERD. Though GERD can develop in people of any age, including children, the likelihood of it doing so increases with age. Treatments to manage GERD include medical, surgical, and lifestyle methods.
The symptoms of GERD often appear or are more severe following meals, when lying on the back, when bending over, and when lifting or straining. Many people experience more severe symptoms at night that awaken them from sleep. Typical GERD symptoms are chronic (ongoing) and include
Some people also experience chronic sore throat or hoarseness resulting from the persistent reflux, or HICCUPS, likely due to irritation of the DIAPHRAGM, where the esophagus and stomach join, which is the site of the irritation. The diagnostic path may include BARIUM SWALLOW, gastroesophagoscopy (endoscopic examination of the esophagus and stomach), and breath or BLOOD tests for the presence of HELICOBACTER PYLORI. Because GERD is so common and the diagnostic procedures are invasive, doctors often use a trial of medication, such as H2 ANTAGONIST (BLOCKER) MEDICATIONS or PROTON PUMP INHIBITOR MEDICATIONS (PPIs), to suppress gastric acid production and then assume a diagnosis of GERD if the medication relieves the symptoms.
Most people obtain full relief from their symptoms with a combination of medical treatments and lifestyle modifications. Many people find lifestyle modifications (diet, WEIGHT LOSS AND WEIGHT MANAGEMENT, SMOKING CESSATION) combined with ANTACIDS adequate, while other people require stronger medications such as H2 blockers or PPIs. Many H2 blockers are available in over-thecounter formulas. Reducing gastric acid significantly reduces the amount reflux that can backwash into the esophagus.
The most common surgical treatment for GERD that fails to improve with medication and lifestyle methods, fundoplication, reinforces the upper section of the stomach (the fundus) to increase tension on the lower esophageal sphincter. There are several fundoplication methods, some of which the surgeon can perform laparoscopically and others that require OPEN SURGERY. Another surgical option is endoscopic gastroplasty to repair or strengthen the lower esophageal sphincter. The most common complications after surgery are INFECTION and difficulty swallowing.
|Treatments for Gastroesophageal Reflux Disorder (GERD)|
|Medical Methods||Surgical Methods||Lifestyle Methods|
antibiotics for H. PYLORI
WEIGHT LOSS AND WEIGHT MANAGEMENT
elevate head of bed
avoid CAFFEINE and ALCOHOL
reduce carbonated beverages
stay upright for 2 hours after meals
sleep lying on the left side
avoid NSAIDS and aspirin
Doctors are uncertain what causes GERD to develop, though various factors appear to contribute. Among them are
Preventive measures include avoiding or minimizing factors associated with GERD as well as eating smaller meals and getting regular physical exercise, which helps maintain effective PERISTALSIS and gastrointestinal motility (movement of food through the gastrointestinal tract).
See also ACHALASIA; BARRETT’S ESOPHAGUS; ENDOSCOPY; ESOPHAGITIS.
Resource: Facts On File Encyclopedia Of Health And Medicine
Dyspepsia - the clinical term for indigestion or heartburn. Most people experience dyspepsia as a burning PAIN in the upper abdomen. Some people also experience NAUSEA, VOMITING, and excessive belching. Certain foods or drinks, such as spicy foods or caffeinated beverages, often worsen the discomfort, as do medications such as aspirin and other NONSTEROIDAL
Digestive hormones - chemical messengers that stimulate or inhibit gastrointestinal functions. Organs and structures of the gastrointestinal system synthesize and release digestive hormones in response to chemical and physiologic changes that take place with the ingestion of food and its passage through the gastrointestinal tract.
Colon - the large intestine, which extracts water from and consolidates the waste byproducts of digestion. The colon extends from the ILEUM, the final segment of the SMALL INTESTINE, to the ANUS, the exit from the body for solid digestive waste (feces or stool). The colon goes up the left side of the abdomen (the ascending colon), across the abdomen at the
Zollinger-Ellison syndrome is a rare disorder in which the STOMACH dramatically increases hydrochloric acid production, resulting in rampant PEPTIC ULCER DISEASE. Zollinger-Ellison syndrome develops as a consequence of benign tumors, called gastrinomas, that secrete the digestive HORMONE gastrin. Gastrin signals the stomach to produce acid, which the
Stomach - the pouchlike organ that receives and digests food. The stomach can stretch up to six times its resting size to accommodate influxes of food and drink up to about the combined quantity of a gallon. Three layers of MUSCLE wrap around the deeply pitted gastric mucosa (mucous membrane lining of the stomach). The fibers of each muscle layer run in
Rectum - the segment of the COLON between the sigmoid colon and the ANUS. About six inches long, the rectum retains solid digestive waste until a BOWEL MOVEMENT expels it. The SPINAL CORD regulates the NERVE impulses that initiate the reflexive contractions of the rectum that result in bowel movements. The walls of the rectum are smooth and flexible,
Anus - the opening through which the body passes solid waste (feces), below the final segment of the COLON and the terminus of the gastrointestinal system. The anal sphincter is a ring of MUSCLE that contracts to contain fecal matter and relaxes to expel it. Learning to control the contraction and relaxation of the anal sphincter begins to take place at age
Cecum - the first segment of the COLON (large intestine) into which the ILEUM, the final segment of the SMALL INTESTINE, empties digestive matter. The cecum is a pouchlike structure located in the lower right abdomen that absorbs water from the waste, returning fluid to the body and consolidating the waste for its journey through the end stage of digestion.
Celiac Disease is a condition affecting the SMALL INTESTINE in which consuming foods that contain gluten, a plant protein prominent in wheat, triggers an inflammatory response that prevents the intestinal mucosa (lining) from absorbing NUTRIENTS. Gluten, and more specifically proteins it contains called gliadins, acts as an ANTIGEN to initiate a localized
Cholecystectomy is a surgical OPERATION to remove the GALLBLADDER. Cholecystectomy is the most common treatment in the United States for GALLBLADDER DISEASE including gallstones (cholelithiasis), cholecystitis (INFLAMMATION or INFECTION of the gallbladder), and biliary dyskinesia (diminished ability of the gallbladder to eject BILE). About 500,000 Americans