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GERD

Definition


Disease: GERD GERD
Category: Digestive diseases

Disease Definition:

When stomach acid or occasionally bile flows back or refluxes into the esophagus, the food pipe, GERD (gastrosophageal reflux disease) occurs, which is a chronic digestive disease. The signs and symptoms of GERD are caused when the lining of the esophagus is irritated due to the backwash of acid.

 

Acid reflux and heartburn are some of the signs and symptoms of GERD, which are common digestive conditions that most people experience from time to time. Someone's condition is termed as GERD in case the signs and symptoms occur more than twice each week or interfere with the person's daily life.

 

Lifestyle changes and over-the-counter medications can usually manage the discomfort of heartburn; however, these remedies could only offer temporary relief for people with GERD. In order to reduce the symptoms of GERD, a person may require stronger medications or even surgery.
 

Work Group:


Symptoms, Causes

Symptoms:

Some of the signs and symptoms of GERD may include:

 

  • Chest pain
  • Dry cough
  • Sensation of a lump in the throat
  • Dysphagia, which is difficulty swallowing
  • Hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Heartburn, which is a burning sensation in the chest that could spread to the throat in some cases, in addition to a sour taste in the mouth.

 

In case someone experiences chest pain, they should seek immediate medical attention, particularly if it’s accompanied with shortness of breath, jaw or arm pain, or other signs and symptoms, which could be the signs and symptoms of a heart attack.

 

In case a person experiences severe or frequent symptoms of GERD, they should see a doctor. A person should also see a doctor in case they use over-the-counter medications more than twice a week.
 

Causes:

Frequent acid reflux, which is the backup of stomach acid or bile into the esophagus, causes GERD.

 

The lower esophageal sphincter, which is a circular band of muscle around the bottom part of the esophagus, relaxes when a person swallows in order to allow food and liquid to flow down into the stomach and then closes again.

 

The stomach acid could flow back up into the esophagus in case this valve relaxes abnormally or weakens disrupting a person's daily life and causing frequent heartburn. The lining of someone's esophagus could be irritated by this constant backwash or acid, causing it to become inflamed. The inflammation could erode the esophagus and cause bleeding or breathing problems along with other complications.
 

Complications

Complications:

The chronic inflammation in the esophagus could lead to complications over time, such as:

 

  • An open sore in the esophagus (esophageal ulcer):
  • The tissue in the esophagus could be severely eroded because of stomach acid, causing an open sore to form. This ulcer could bleed, make swallowing difficult and cause pain.

 

Narrowing of the esophagus (esophageal stricture):

Scar tissue could be formed due to damage to the cells in the lower esophagus from acid exposure. Difficulty swallowing will result because the scar tissue will narrow the food pathway.

Precancerous changes to the esophagus (Barrett's esophagus):

The color and composition of tissue that lines the lower esophagus change in Barrett's esophagus. These are changes that are linked with an increased risk of esophageal cancer. A person with Barrett's esophagus will be recommended regular endoscopy exams in order to look for early warning signs of esophageal cancer, despite the fact that the risk of cancer is low.
 

Treatments:

Over-the-counter medications that control acid are the first step of treatment for heartburn and other signs and symptoms of GERD. Someone with this condition may be recommended other treatments including medications and surgery in case they don't find relief within a few weeks.

 

INITIAL TREATMENTS TO CONTROL HEARTBURN:

Some of the over-the-counter medications that could help in controlling heartburn include:

Antacids that neutralize stomach acid:

Although antacids alone don't heal an inflamed esophagus that has been damaged by stomach acid, however, they do provide quick relief. Diarrhea and constipation are some of the side effects of antacids that occur with overuse.

Medications that block acid production and heal the esophagus:

The production of acid is blocked by proton pump inhibitors, which allows time for the damaged esophageal tissue to heal. Omeprazole and lansoprazole are some examples of over-the-counter proton pump inhibitors.

Medications to reduce acid production:

Some examples are famotidine, ranitidine, cimetidine and nizatidine. These medications are called H-2-receptor blockers, which could provide long relief despite the fact that they don't work as fast as antacids. There are stronger versions of these medications which are available in prescription form.

 

In case these medications don't help after a few weeks, a doctor should be contacted.

Prescription-strength medications:

Someone may be recommended prescription-strength medications in case heartburn persists despite initial approaches. These medications include:

Medications to strengthen the lower esophageal sphincter:

These medications will help the stomach empty more rapidly and help tighten the valve between the stomach and the esophagus. Also called prokinetic agents, the usefulness of these medications are limited because some of their side effects include depression, fatigue, anxiety and other neurological problems.

Prescription-strength H-2-receptor blockers:

Prescription-strength nizatidine, cimetidine, ranitidine and famotidine are some of these medications.

Prescription-strength proton pump inhibitors:

Pantoprazole, esomeprazole, omeprazole, lansoprazole and rabeprazole are some examples of these medications.

 

In order to increase the effectiveness of these medications, they are sometimes combined.

 

SURGERY AND OTHER PROCEDURES:

Usually, medications control most cases of GERD. However, a person may be recommended some more invasive procedures in case medications are not helpful, or if they wish to avoid long-term medication use, including:

Surgery to reinforce  the lower esophageal sphincter:

In this surgery, the lower esophageal sphincter is tightened by wrapping the very top of the stomach around the outside of the lower esophagus in order to prevent reflux. Also called Nissen fundoplication, this surgery could be open with a bid incision in the abdomen, or it could be laparoscopic, with three or four small incisions in the abdomen, and the instruments will be inserted through these small incisions, such as a flexible tube with a tiny camera.

A procedure to form scar tissue in the esophagus:

In this procedure, electrode energy is used in order to heat the esophageal tissue. This heat will damage the nerves that respond to refluxed acid and create scar tissue. The scar tissue that will form as the esophagus heals will help in strengthening the muscles. Research is still ongoing about this procedure which is also called the Stretta system, and it is still not clear who is best suited for it.

Surgery to create a barrier preventing the backup of stomach acid:

In this surgery, a tool resembling a miniature sewing machine is used. This tool will place pairs of stitches or sutures in the stomach near the weakened sphincter, and then the suturing material will be tied together creating a barrier that prevents stomach acid from washing into the esophagus. Research is still ongoing about this procedure which is also called EndoCinch endoluminal gastroplication, and it is still not clear who is best suited for it.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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Consultants Corner

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist
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