Gastroesophageal reflux disease, or GERD, is a digestive disorder where acid and stomach contents shoot back into the esophagus - causing damage to the mucosal lining. This typically manifests in symptoms such as heartburn and regurgitation, though these symptoms must be chronic if the condition is to be diagnosed as GERD. Treatment options range from dietary and lifestyle changes, through to the use of medication and surgery. Research shows that GERD affects up to 20% of Western populations - though considerably more are affected in older adults.
The most characteristic symptoms of GERD are heartburn and regurgitation. Heartburn is caused as highly acidic contents of the stomach reflux back into the esophagus, irritating the lower wall of the esophagus. Many patients will also suffer from regurgitation, whereby contents of the stomach will rise considerably higher and, ultimately, disrupt the lifestyle of the patient. Less commonly seen, though by no means rare, are symptoms of chest pain, pain swallowing, and sore throat. If these symptoms persist untreated over a prolonged period of time, it may result in a condition known as Barrett's esophagus - a condition that predisposes the esophagus to the formation of cancer.
GERD is caused by the reflux of acid and stomach contents back into the walls of the esophagus. Under normal circumstances, this reflux does not take place as a flap of muscle - known as the esophageal sphincter - shields the esophagus from the contents of the stomach. If this flap of muscle were to loosen up, it would consequently render it easier for contents to splash back into the esophagus - which is precisely what happens in GERD. When stomach contents travel back into the esophagus, it invariably damages and inflames its mucosal lining, giving off the characteristic symptom of heartburn. The risk of GERD increases in patients with pre-existing obesity, hiatal hernia, and stomach cancer.
GERD may be diagnosed simply based on the symptoms present. This is particularly true if the patient responds positively to the use of medication used to combat the associated symptoms. However, sometimes more objective tests are employed to fully evaluate what the patient is experiencing. One such test, known as esophageal pH monitoring, actively examines the rate of reflux of acidic material into the esophagus. If the pH is consistently low (indicating high presence of acid), it points to the presence of reflux. Alternatively, the physician may recommend endoscopy - though this procedure is usually limited to those who have accompanying symptoms such as weight loss, pain on swallowing, and bloody feces.
Treatment options vary - ranging from lifestyle changes and medication to more extreme methods such as surgical intervention. Some foods, such as fatty and spicy food, are often implicated or directly associated with the symptoms of an individual patient, and it would be advised to avoid such associated dietary links. Other dietary changes, such as weight loss and exercise, have also proven beneficial.
In tandem with this, physicians will usually prescribe drugs known as proton-pump inhibitors (PPIs), such as omeprazole. Omeprazole works by suppressing acid formation in the stomach. Alternatively, surgical intervention may be advised, such as the Nissen fundoplication. This standard surgery works by wrapping part of the stomach around the esophagus, thereby preventing acid reflux into the mucosal lining. It has proven just as successful as conventional medication in preventing the symptoms associated with GERD.
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