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GERD (Gastroesophageal reflux disease)What is GERD (Gastroesophageal reflux disease) The normal process of eating food begins with chewing in the mouth. After you are able to chew up your food and roll it into small enough portions to swallow, the food travels down a tube called the esophagus into the stomach. At the very end of the esophagus there is a ring of muscle that acts as a gate into the stomach called the lower esophageal sphincter (LES). When you are swallowing food down your esophagus, this ring of muscle relaxes (opens up) and allows your food to pass easily into the stomach. And similarly, after the food has passed into the stomach and you are done eating, the lower esophageal sphincter tightens back up (closes) and prevents food from coming back up and out. Reflux occurs when the LES is relaxed or when the stomach is so full of food and or liquids that the contents are able to push through the muscular gate back into the esophagus (tube back to the mouth). Some reflux is a normal process that occurs in healthy people of all ages, from infants to adults. However, normally reflux should only happen every now and then (after a big meal or when lying down after eating) and should not cause you any big problems. In GERD, however, people experience symptoms such as heartburn, vomiting, chest pain, etc. on a more regular basis and the reflux of stuff from your stomach can actually damage your esophagus on the way back up. What causes GERD (Gastroesophageal reflux disease) In people with GERD, this gate in and out of the stomach doesn’t work as well as it should. This may be due to several things. 1. Over consumption (eating too much)- Some people just eat too much every time they eat and fill their stomachs so full of food that food pushes its way back up and out. 2. Resting after eating -Believe it or not, gravity does play a big role in keeping your food down in your stomach. When you lay down, you lose this help and food can come back up much easier. 3. High fat diet-Fatty foods take longer to break down in the stomach, so they fill your stomach up longer and have time to come back out. 4. Alcohol use- Alcohol is actually is absorbed quickly in your stomach, however, it causes your LES (that gate to your stomach) to open up and relax. This is one of the reasons you get heartburn more often when you drink 5. Pregnancy- women experience big changes in the hormones (signals the body uses to communicate with itself) in their body when they are pregnant. One of these hormones, called progesterone, goes way up in pregnancy. It plays a big role in making the baby healthy, but it also causes the LES to relax and open up (much like alcohol). 6. Hiatal Hernia- this is just a fancy medical term that describes the condition when part or all of your stomach is above the diaphragm (a flat muscle just below your lungs that is what keeps you breathing). Normally the esophagus comes down and through a hole in the diaphragm to get to the stomach. In fact, the diaphragm pushing on the esophagus actually helps prevent reflux of food back up as it helps the LES keep the esophagus closed. However, if you have a hiatal hernia, the part of the stomach that the esophagus comes into (or even the entire stomach) has come through that hole in the diaphragm. People with hiatal hernias are at a much high risk of getting GERD. What causes your stomach to come through the diaphragm is not known, but you are at risk if you are over 50 years old, overweight or pregnant. What are some things people with GERD (Gastroesophageal reflux disease) experience 1. Stomach pain- especially in the upper part of you belly. 2. Chest pain-please see your doctor as soon as you can if you are having chest pains of any kind. However, chest pain with GERD is often right in the center of your chest. This pain can be moderate to severe, however it can be so severe that people can think they are having a heart attack. 3. Cough- a long term cough is one of the big signs of reflux disease. People often have the sensation that they need to clear their throat. You usually do not cough anything up if the cough is from GERD. 4. Pain or difficulty with swallowing- when you have reflux of food and acid back out of your stomach into the esophagus, the esophagus gets damaged and can start to scar shut a bit. This causes pain with swallowing or trouble swallowing as the tube gets smaller and the food has more trouble getting through. 5. Sore throat or the feeling that you have a lump in your throat 6. Hoarse voice- reflux can actually damage your vocal cords (bands of tissue that allow you to form speech). If the acid comes back up and reaches your vocal cords you often have a scratchy or hoarse voice 7. Poor dentition or worsening dental disease- reflux can come all the way back up into your mouth and damage your teeth. 8. Repeated episodes of pneumonia- reflux can come back up and actually make its way into your lungs if you are in the process of breathing. This can lead to episodes of pneumonia (infection in your lungs). **If you have pain with swallowing, chest pain or repeated episodes of choking, please see your doctor immediately.** Why should GERD be treated Most people with reflux will not develop serious complications, however the following things can and do happen with reflux and should be prevented. 1. Strictures- this is just a fancy medical term for thinning of your esophagus. Recall damage to the esophagus from the reflux can cause the tube to scar shut somewhat. This can lead to trouble swallowing and pain with swallowing. 2. Ulcers- these are erosions in the wall of the esophagus from the damage by the reflux. Think of a scab on your arm after a fall if you are not sure what an ulcer is. The big problem with ulcers is bleeding. Patients over time can lose a lot of blood. 3. Barrett’s esophagus and cancer- Barrett’s esophagus is the medical condition where the lining of your esophagus begins to change into a different type of tissue due to the long term damage from the reflux. Barrett’s esophagus itself is not harmful, however it is an alarm to your doctor as it is a step along the way to developing esophageal cancer. How is GERD (Gastroesophageal reflux disease) diagnosed? Most GERD is diagnosed by your symptoms and a positive response to anti-reflux medications or lifestyle changes (see below). However, other ways exist to diagnose this disease, especially when your symptoms are not perfectly clear or when your doctor is worried about something else. Other ways to diagnose GERD are by: 1. Endoscopy- This is when your doctor uses a small, flexible tube with a camera on the end to look down into your esophagus. Your doctor can use the camera to see the wall of your esophagus and see if any damage is taking place. 2. 24 hour pH study- this involves placing a tube down your nose and into your esophagus for an entire day. The tube is attached to a machine that measures how much reflux (acid from the stomach) is reaching into the esophagus. How is GERD (Gastroesophageal reflux disease) treated? Your doctors first recommendations, if your GERD is mild are likely to be lifestyle changes. These include eating smaller meals, eating several hours before going to bed, decreasing alcohol consumption, stopping smoking and losing weight. Little things can be done to help as well including sleeping with an extra pillow or two under your head to prevent you from laying completely flat and avoiding foods such as chocolate, caffeine (coffee, soda). When lifestyle changes do not do the job, medications can be tried as well. To read about your specific reflux medication please see our medications link. In general medications for GERD work by decreasing the amount of acid produced by your stomach. Normally, some is good as it is needed to break down food, however in GERD you often have too much. Finally, if medications and lifestyle changes do not work or your symptoms of GERD are very severe, surgery can be performed. In general, surgery for GERD involves fixing a hiatal hernia (see above) if one exists and or strengthening the LES (that gate into your stomach) to help prevent reflux from coming back up. | |
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