GERD ( gastroesophageal reflux disease ) : Causes, Symptoms , Diagnosis, Treatment
Gastroenterology / / May 01, 2016
Gastroesophageal reflux disease (GERD) - a chronic relapsing disease caused by the spontaneous, regularly repeated reflux, reflux promotion content stomach or duodenum, through the lower esophageal sphincter, back into the esophagus.Reflux occurs when the muscle activities of the lower esophagus or other protective mechanisms fail.
distinctive feature of GERD symptoms are:
- heartburn - a burning sensation in the chest and throat;
- regurgitation - a burning sensation from the accumulation of acid in the esophagus.Although
acid is the main factor of the damage caused by GERD may also be other harmful products of the gastrointestinal tract, including pepsin and bile.
Heartburn - a condition in which acid from the stomach travels back into the esophagus, causing pain in the chest.Reflux typically is because the sphincter muscle between the esophagus and the stomach weakened.Vertical position standing or sitting after meals can help reduce reflux which causes heartburn.Con
esophagus - is a narrow muscular tube length of 25-30 cm It starts under the tongue and ends at the stomach..esophageal tube ?? narrow in the upper and lower parts, but in the middle of it - slightly narrowed.
esophagus consists of three main layers:
- the outer layer of fibrous tissue;
- the middle layer containing smooth muscle;
- the inner membrane, which contains many tiny glands.
When a person ingests food, the esophagus moves it in the stomach under the influence of wave-like muscle contractions - peristalsis.The stomach acid and enzymes destroy various starch, proteins and fats from food.The mucous membrane of the stomach has a thin layer of mucus that protects it from these liquids.
After a person swallows, the sphincter opens and the food enters the stomach.It then immediately closes to prevent regurgitation of stomach contents including stomach acids.NPC supports this barrier pressure for food, that it is not swallowed again.If the barrier is not enough pressure to prevent regurgitation, and if acid reflux support, esophageal peristaltic action serves as an additional protective mechanism, pushing back up the contents back into the stomach.If
acid and enzymes go back into the esophagus, it gives only weak lining protection against these agents.Instead, there are other factors to protect the esophagus.The most important structure for this just serves as the lower esophageal sphincter (LES) - a group of circular muscles around the lower part of the esophagus, on the border with the stomach.Typically, when the food or liquid to enter the stomach, LES closes the esophagus.If the NPC does not close tightly enough after cooking, going to the stomach, the stomach contents can back up (reflux) into the esophagus.This partially digested material can irritate the esophagus, causing heartburn and other symptoms.
He who eats a lot of acidic foods can be mild, temporary heartburn.This is especially true when lifting, bending or lying down after eating, especially after eating greasy or acidic foods.Persistent GERD, however, may be associated with various conditions, including biological or structural problems:
- Fault muscle of the lower esophageal sphincter (LES). group of muscle tissue called NPS.It is responsible for opening and closing the lower part of the esophagus, and is essential for maintaining the barrier pressure on the stomach contents.To NPC function properly, do not let up, and did not lose the tone should be the interaction of smooth muscles and various hormones.Dietary substances, drugs, and nervous system factors can weaken the LES and impair its function.
- Violation of the functions of the stomach. GERD patients have abnormal nerve and muscle function in the stomach.These disorders result in delays in gastric emptying, increasing the risk for congestion acids.
- Abnormalities in the esophagus. Some studies show that most people with atypical symptoms of GERD (eg, hoarseness, chronic cough, or a feeling of a lump in the throat) may have certain abnormalities in the esophagus.
- Anomalies mobility. Problems spontaneous muscle action (peristalsis) of the esophagus in GERD usually occur, although it is not clear whether they call themselves GERD or are the result of long-term GERD.
- esophageal rings in adults. People with this disease have a lot of rings on the esophagus and the persistent problems with swallowing (and also received food stuck in the esophagus).It occurs mostly in men.
- hiatal hernia. This small hole in the membrane through which the esophagus enters the stomach.It is generally small, but it can come to a weakening and an increase.When this happens, part of the abdominal muscles can intrude into it, creating a condition called "hiatal hernia".Very often it occurs in more than half of people over 60 years, and rarely serious.It was once believed that in most cases, persistent heartburn caused by a hiatal hernia.Indeed, such a hernia can lead to dysfunction of the abdominal muscles.However, studies have not been able to confirm that it is a common cause of GERD, although its presence may increase symptoms of GERD in patients who have both conditions.Hernia occurs when a portion of the stomach protrudes upward in the thorax through the diaphragm muscle layer.This may be a result of weakening of the surrounding tissues, and may be aggravated by smoking or obesity.
- Genetic factors. In 30-40% of reflux can be hereditary.The risk of inheritance exists in many cases, GERD may be due to genetic muscular or structural problems in the stomach or esophagus.Genetic factors may play a particularly important role in susceptibility to Barrett's esophagus, a precancerous condition caused by very severe GERD
- Crohn's Disease. It is a chronic disease that causes inflammation and damage to the small intestine, the colon and other parts of the gastrointestinal tract, including the esophagus sometimes.Other disorders that may contribute to GERD include: diabetes, any gastrointestinal disorders (including peptic ulcer disease), lymphomas and other cancers.
- Helicobacter Pylori. Helicobacter pylori (or H. Pylori) - a bacterium that is sometimes found in the gastric mucosa.It is now known that it is one of the major causes of peptic ulcer to be treated with antibiotics.Some concern studies indicate that H. Pylori may actually protect against GERD by reducing gastric acid.But the treatment of ulcers in the background to eliminate the bacteria H. Pylori in some people can cause GERD.The bacteria must be eradicated from infected patients with existing GERD who take medications to suppress acid.There is some evidence that the combination of H. Pylori and chronic suppression of acid in these patients may lead to atrophic gastritis or precancerous conditions in the stomach.
- Drugs that increase the risk of GERD: many nonsteroidal anti-inflammatory drugs (NSAIDs) - common causes of peptic ulcer disease, which can also cause GERD or increase its severity;calcium channel blockers (used to treat high blood pressure and angina pectoris);anticholinergics (used to treat urinary tract disorders, glaucoma and allergies);beta-adrenergic agonists (used to treat asthma and obstructive lung disease);dopamine agonists (used in Parkinson's disease);bisphosphonates (used to treat osteoporosis);sedatives;antibiotics;potassium;iron pills.
Risk factors for heartburn and gastroesophageal reflux disease
- Power. People who eat a heavy meal and then lay down on his back or bend from the waist, are at risk of heartburn.Anyone who has a snack before bedtime, have a high risk of heartburn.
- Pregnancy. Pregnant women are particularly vulnerable to GERD in the third trimester of pregnancy, because the uterus is growing more and more pressure on the abdomen.Heartburn in such cases are often resistant to diet therapy and even antacids (medicines for the treatment of acid-related diseases of the gastrointestinal tract through the neutralization of hydrochloric acid, which is part of the gastric juice).
- Obesity. number of studies have shown that obesity contributes to GERD, and GERD patients, it may increase the risk of erosive esophagitis (severe inflammation is in the esophagus).Studies show that the presence of excess fat in the abdomen may be the most important risk factor for the development of acid reflux and related complications - such as Barrett's esophagus (one of the major complications in the background of GERD, a condition of the esophagus, which is a major risk factor, previous canceresophagus) and esophageal cancer.The researchers also report that increased body mass index is associated with the most severe symptoms of GERD.Weight loss may very well help to reduce the symptoms of GERD.This gastric banding surgery to combat obesity may actually increase the risk of GERD symptoms worsen.
- Respiratory Diseases. People with asthma have a very high risk of GERD.Between 50% and 90% of patients with asthma have some symptoms of GERD.People with chronic obstructive pulmonary disease (COPD) (from "obstruction" - an obstacle, hindrance, obstacle: resistance to normal operation; airway obstruction - obstruction of the respiratory tract syndrome, can occur at any level, from the pharynx to the bronchioles) and are at increased risk of GERDand GERD may aggravate pre-existing COPD.
- Smoking. There is increasing evidence that smoking increases the risk of GERD.Studies show that smoking reduces the function of the muscles, increases the secretion of acid weakens the muscles and reflexes NPCs in the throat, as well as damage the protective mucous membranes.Smoking decreases the saliva, and saliva helps neutralize the acid.It is unknown whether the smoke result, nicotine or both of the trigger (generally, "something resulting effect element") to GERD.Some people who use nicotine patches to quit smoking, suffer from heartburn.Moreover, smoking may lead to emphysema (COPD), which is itself a risk factor for GERD.
- Alcohol. Alcohol has an ambiguous effect on GERD.It relaxes the muscles of the NPC and at the same time can irritate the esophageal mucosa.It should be noted that the combination of alcohol and smoking increases the risk of developing esophageal cancer.
- Hormone replacement therapy. GERD symptoms are more common in postmenopausal women receiving hormone replacement therapy.The risk increases with larger doses of an estrogen and a long duration of therapy.
Symptoms of heartburn and gastroesophageal reflux disease (GERD)
- Heartburn. Heartburn is the main symptom of GERD.This burning sensation that extends upward from the stomach to the chest and throat.Heartburn is most likely due to the following activities:
- by eating a heavy meal;
- when bending;
- at elevations;
- lying down, especially on the back.
All patients with GERD at night, tend to feel greater pain than another time of the day.
severity of heartburn does not necessarily indicate the actual damage to the esophagus.For example, Barrett's esophagus, which causes precancerous lesions in the esophagus, can detect only a few symptoms, particularly in elderly people.On the other hand, people have heartburn can be painful, but - without damage to the esophagus.
- Dyspepsia. About half of patients with GERD have dyspepsia - a syndrome that consists of the following:
- pain and discomfort in the upper abdomen;
- feeling of fullness in the stomach;
- nausea after eating;
- regurgitation.Regurgitation - this feeling of acid and its accumulation in the throat.Sometimes acid erupts in the mouth and can be perceived as a "wet burp."It can come out as vomiting.People without GERD may also have dyspepsia.
- Feeling chest pain. Patients may have a feeling that the food - "trapped" behind the breastbone.Chest pain - a common symptom of GERD.This is very important - to distinguish it from chest pain caused by heart problems (angina, heart attack, etc.).
- Symptoms of throat. Less GERD can cause symptoms in the throat:
- Acid larringit.Ssostoyanie, which is accompanied by hoarseness, dry cough, lump sensation in the throat and cough is often necessary;
- trouble swallowing (dysphagia).In severe cases, patients may be in shock, and the food can get stuck in their esophagus, causing severe pain in the chest.This may indicate a temporary spasm that narrows the pipe or serious damage or abnormalities in the esophagus;
- a chronic sore throat;
- persistent hiccups;
- cough, and respiratory (breathing) symptoms - coughing, wheezing, etc .;
- chronic nausea and vomiting.Nausea persists for several weeks or even months, and does not rise to frequent cause gastric disorders, includingSymptoms of heartburn.In rare cases, vomiting may occur more than once a day.All other causes of chronic nausea and vomiting should be excluded, including ulcers, gastric cancer, ileus, diseases of the pancreas or gallbladder.
Diagnostics heartburn and gastroesophageal reflux disease (GERD)
man with chronic heartburn, probably has GERD (heartburn but do not necessarily indicate the presence of GERD).
doctor can usually diagnose GERD if the patient finds relief from constant heartburn and acid regurgitation after taking antacids for short periods of time.If the diagnosis is not clear, but the doctor suspects GERD studies are conducted with the use of proton pump inhibitors (PPIs) - these are medications like omeprazole (Prilosec).They identify 80-90% of people with this disease.This class of drugs blocks the secretion of gastric acid.
may require laboratory or invasive (involving the invasion of the patient's body) tests, including an endoscopy (imaging technique, or exploring some of the internal organs with the help of a special optical device - an endoscope, a medical and diagnostic purposes), if:
- diagnosis of allIt is still uncertain;
- symptoms are not typical;
- suspected Barrett's esophagus;
- there are complications such as: signs of bleeding or difficulty swallowing.
Some of these medical tests are listed below:
- X-ray with barium swallowing;
- upper endoscopy;
- capsule endoscopy;
- esophageal cancer and Barrett's monitoring;
- blood tests and stool;
- Test Bernstein;
- exclusion of other disorders;
- sore throat and chest pain;
- other diseases.
Treatment of heartburn and gastroesophageal reflux disease (GERD)
acid suppression continues to be the mainstay for the treatment of GERD.The aim of drug therapy is to reduce the amount of acid and reducing any abnormalities in muscle function NPS esophagus or stomach.In most cases, gastroesophageal reflux soft, and you can control it with lifestyle changes, as well as prescription drugs and antacids.
- Medication. Patients with moderate to severe symptoms of GERD who do not respond to changes in lifestyle, or those who are diagnosed at a late stage, may be prescribed medications of different strengths, depending on complications at diagnosis.