Gastroesophageal reflux disease is defined as the regurgitation or rise of stomach contents into the esophagus. The esophagus is joined to the stomach by a valve or sphincter called the lower esophageal sphincter, which allows the passage of food to close later.
If it does not work well and does not close after the food has entered, the gastric content (which is acidic) will ascend to the esophagus.
Several factors can precipitate the onset of this disorder:
- Age, gender, and race are not risk factors.
- Obesity increases the risk of the body mass index (BMI) increases.
- Diet: Foods that can cause sphincter dysfunction: Citrus fruits, Carbonated drinks, caffeine, chocolate, onion, spices, high-fat foods, mint and spearmint, alcohol
- Physical Exercise: Intense: Could aggravate symptoms. Moderate: This could be a protective factor.
- Tobacco and Alcohol: Tobacco: Increases the risk. Alcohol: It has not yet been confirmed if it increases the risk of GERD.
- Medications: They decrease the pressure of the LES, and others reduce the gastrointestinal transit. They can make GERD symptoms worse. Examples: Benzodiazepines, Anticholinergics, Beta Agonists, Alpha Antagonists, Calcium Antagonists, Dopamine, Theophylline (Aminophylline), Nitrates, Serotonin, Morphine, Prostaglandins E2, and I2, Alendronate, Progesterone, and Secretin
- Sleeping position: Right lateral decubitus: increases the risk. Elevate the head of the bed: Reduces the risk.
- Hiatus hernia: Part of the stomach rises through the diaphragm into the chest, hindering the function of the lower esophageal sphincter and favoring reflux. The association hiatal hernia – Gastroesophageal Reflux is frequent, but Hiatal hernias without GERD and GERD without hiatal hernia.
What are the symptoms?
The characteristic symptoms of GERD are heartburn (Sensation of acidity or burning in the center of the chest and that extends towards the neck), regurgitation (Sensation that food or liquids return to the mouth again, especially when bending over or lying down), cough, throat clearing, morning hoarseness, and dysphagia (over the years, GERD can cause difficulty in passing food down the esophagus).
Gastroesophageal reflux disease is chronic with episodes of variable intensity and periods of remission. The presence or severity of symptoms bears little relation to the company or severity of esophagitis.
Due to the corrosive action of gastric acid on the esophagus, gastroesophageal reflux disease predisposes to the appearance of erosions or ulcers in the esophagus (esophagitis).
Barrett’s esophagus is a rare complication of GERD. In this disease, the esophageal mucosa is constantly attacked by stomach acid, transforming it into a mucosa similar to the intestine.
The presence of Barrett’s esophagus predisposes to the appearance of pre-tumor lesions, so patients with this disorder should be monitored periodically using gastroscopies and biopsies.
GERD is diagnosed clinically (heartburn, regurgitation, etc.), a gastroscopy is not necessary, and it will only be performed in the event of alarm symptoms (difficulty swallowing, anemia, or weight loss).
The pH meter would allow us to know when the gastric juice is in contact with the esophageal mucosa, and it is only carried out in specific situations.
What treatment do you have?
The treatment that we have to follow is divided into:
- Dietary measures: Healthy lifestyle habits, avoid being overweight, copious meals, foods that cause heartburn, tobacco, alcoholic beverages, carbonated beverages, citrus juices, and going to bed within 2-3 hours after meals. If nocturnal symptoms, raise the head of the bed to sleep on the left side. GERD patients should engage in regular physical activity for 30 minutes or more a day but avoid intense physical activity.
- a) Proton pump inhibitors (PPIs) inhibit the acid secretion produced in the stomach and are the treatment of choice both in the acute phase and during the maintenance phase of GERD. Examples: Omeprazole, rabeprazole, pantoprazole, lansoprazole, esomeprazole…
- b) Antacids and alginates: They neutralize acid secretion and create a barrier effect. Currently, they play a secondary role. Indication: Symptomatic control in mild cases; relief of sporadic symptoms that may appear while treated with other drugs: Sodium bicarbonate, magnesium hydroxide, almagate (Almax).
- c) Prokinetics: They improve gastric emptying. Minimal paper
- d) Anti-H2 (Antihistamines): Less effective than PPIs. The valid alternative is in forms with mild symptoms and associated with a PPI with persistent nocturnal symptoms. They may be an option for maintenance treatment in patients with typical GERD syndrome and mild/infrequent symptoms. Examples: Ranitidine, cimetidine
- Surgical Treatment: Surgical treatment of GERD is called anti-reflux surgery. It is indicated in some cases in which pharmacological treatment fails, in certain patients with peptic stenosis or Barrett’s esophagus. It can be considered in young patients who require continuous PPI intake to control their symptoms. It is usually done laparoscopically and is called a Nissen fundoplication.