GERD - Gastroesophageal reflux disease Symptoms and treatment

Gastroesophageal reflux disease occurs when stomach acidic and gastric content, back up from the stomach into the esophagus.
GERD can occur at any age and it is one of the most common disorder. It affects around 20 % of US population.
The main symptom of GERD is Heartburn.
Heartburn is a painful burning sensation in the middle of your chest, caused by irritation to the lining of the esophagus caused by stomach acid. Regurgitation is a retrograde migration of acidic gastric contents into the mouth or hypopharynx.
It is often worse after eating, or during reclined position, when they lie in bed.
GERD also characterized by acid taste in mouth.
Other symptoms can be:
painful swallowing, difficulty swallowing, belching, epigastric pain, and nausea.
The presentation is considered to be atypical, when patients present with extraesophageal symptoms, such as chest pain, chronic cough, asthma, laryngitis, dental erosions, dysphonia, and hoarseness.
The Mechanism of GERD is decreased tone of the lower esophageal sphincter, and presence of a hiatal hernia, and esophageal motility.
People with asthma are at higher risk of developing Gastroesophageal reflux disease.
Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back.
On the other hand, Gastroesophageal reflux disease can also cause Asthma by irritating the airways and lungs by refluxed acids.
Risk Factors for GERD include:
Obesity, pregnancy, smoking, hiatal hernia, and taking Medications that may cause or worsen the disease include benzodiazepines, calcium channel blockers, tricyclic antidepressants, Non steroidal anti inflammatory drugs, and certain asthma medicines.
The diagnosis of GERD is made solely based on presenting symptoms or in combination with other factors such as responsiveness to antisecretory therapy, esophagogastroduodenoscopy, and ambulatory reflux monitoring.
Main goal of Treatment is resolution of symptoms and prevent complications such as esophagitis, and esophageal adenocarcinoma.
Lifestyle modifications are considered to be the cornerstone of any GERD therapy.
Weight Loss. avoiding meals at least 3 hours before bedtime and maintaining good sleep hygiene.
Diet modification with the elimination of chocolate, caffeine, and spicy foods, citrus, and carbonated beverages in GERD is controversial and is not routinely recommended as per current ACG guidelines but it can have some benefits.
Medical therapy is comprised of antacids antisecretory agents like histamine (H2) receptor antagonists (H2RAs) or PPI therapy and prokinetic agents.
Famotidine and cimetidine are FDA approved over-the-counter agents.
Also proton pump inhibitors: omeprazole, lansoprazole, and esomeprazole, are available over-the-counter.
Pantoprazole, Dexlansoprazole, and rabeprazole are prescription-only medications.
Proton pump inhibitors (omeprazole, lansoprazole and etc.) are felt to be equally effective and patients should take these medications 30-60 min prior to meals; the exception to this is dexlansoprazole which can be taken irrespective of food intake.
Left untreated, GERD can result in several serious complications, including esophagitis and Barrett’s esophagus. Esophagitis can vary widely in severity with severe cases resulting in extensive erosions, ulcerations and narrowing of the esophagus.
Patients with persistent acid reflux may be at risk for Barrett’s esophagus, defined as intestinal metaplasia of the esophagus. Barrett’s esophagus have potential to progress to esophageal adenocarcinoma.
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