Gastric Esophageal Reflux Disease (GERD): Causes, Sign Symptoms, Diagnosis, Complications and Treatment
Introduction
GERD is caused by the abnormal backflow of acidic gastric
contents of the stomach into the esophagus mostly and may up to the throat and
mouth too.
What are the causing factors that lead to GERD?
Causes and Risk Factors
- Lower esophageal sphincter abnormalities: The lower esophageal sphincter is tonically contracted under normal circumstances, relaxing only during swallowing. In GERD patients its tone is reduced.
- Hiatus hernia: Hiatus hernia is the herniation of part of the stomach into the chest. Occurs in 30% of the population over the age of 50 years
- Delayed esophageal clearance: Esophagus due to reduced the peristaltic activity takes more time than normal to be cleared.
- Defective gastric emptying: Gastric emptying is delayed in patients with gastro-oesophageal reflux disease. The reason is unknown.
- Increased intra-abdominal pressure: Pregnancy and obesity are predisposing causes. Weight loss may improve symptoms.
- Dietary and environmental factors: Dietary fat, chocolate, alcohol, peppermint, tea, and coffee relax the lower esophageal sphincter and may provoke symptoms
- Drugs: Anticholinergic, calcium channel blockers and nitrates.
With what signs and symptoms a GERD patient can present?
Clinical Features: Sign & Symptoms
A patient with GERD can present with;
- Heartburn (burning substernal pain) and Regurgitation, both are the major symptoms
- Sore throat
- Metal like taste
- Hoarseness
- Cough
- Atypical chest pain that may be severe and can mimic angina
- Recurrent chest infections (because of the aspiration of refluxed acid)
Symptoms become worse after a meal or while lying flat.
What are the signs and symptoms, GERD can cause in children?
How can we diagnose GERD?
Diagnosis
The most accurate test is a 24-hour pH monitoring, an electrode is placed several centimeters
above the gastro-esophageal junction, and a determination is made of what the
average pH is in that area.
ECG and Endoscopy will be normal.
How can we treat or manage it?
Treatment & Management
If a patient presents with above symptoms that are mild and
intermittent, initiate the treatment with H2 blockers (cimetidine, famotidine, nizatidine, and ranitidine)
If a patient presents with above symptoms that are moderate and persistent, treat the patient with Proton pump inhibitors_PPIs (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, dexlansoprazole)
Make sure the patient is taking properly (30-60 minutes before meals)
Life modification:
- You must have to incline your bed at approximately half feet from your head side in case of continuous GERD, it prevents upward backflow of acidic content.
- Diet to Avoid: Avoid dietary fat, chocolate, alcohol, peppermint, tea, coffee, spicy, oily, and fried food.
- Diet to include: Less spicy foods, curd, Papaya, Apple, Guavas, and Aloe vera. These will help you to maintain pH (1.5 to 2.5) of stomach.
- Have a better sleep and must do walk.
- Don't sleep immediately after meals.
If you really want to get rid of GERD you must have to pay a keen focus on life modification, and once you succeed in it you would never need any kind of medication in the future.
What if a patient doesn’t show improvement with medicines?
A few patients (<5%) need surgical approach who don’t
respond to medical treatment, these patients require surgery to tighten the
Lower esophageal sphincter.
Comments
Post a Comment