gastroesophageal reflux disease

Gastroesophageal reflux disease summary

Gastroesophageal Reflux Disease (or also Gastroesophageal Reflux Disease – GERD) is a chronic disease in which the acidic contents of the stomach return to the esophagus, injuring it.

The number of patients with gastroesophageal reflux disease (GERD) has increased in recent years. Mainly due to poor eating habits and the increase in overweight or obese people, according to the World Health Organization (WHO).

It is estimated that 10-15% of the western population has the disease and 5% of the eastern population suffer from GERD. In Brazil, there are no precise data on the prevalence of the disease.

GERD occurs when gastric contents flow into the esophagus due to failures in the tone of the lower esophageal sphincter. Inadequate food, stress, smoking, alcohol consumption and overweight are some of the factors that trigger the disease. Diabetic patients, pregnant women and obese patients are at increased risk of the disease.

Symptoms include burning, chest pain, shortness of breath and wheezing.
The diagnosis is made by a specialist doctor who may order some tests, such as pH monitoring, scintigraphy, X-rays and upper digestive endoscopy.

Some complications presented are esophagitis and Barrett’s esophagus, a condition that increases the risk of cancer.

Treatments are based on the use of medications that decrease the amount of acid produced, such as antacids, histamine receptor inhibitors and proton pump inhibitors. In addition, prokinetics are useful in the treatment.

Some medicinal plants such as chamomile and licorice as well as homeopathic medicines can help in the treatment.

It is important for the patient to follow a correct and adequate diet, reduce smoking and alcohol consumption, maintain a healthy weight and reduce stress in order to avoid episodes of GERD.

Questions and Answers
“I have unusually bad breath, it comes out through breathing because of the strong odor. I don’t know anymore but what to do my social life sucks. I have gastritis and I came to think that’s why. The name of the gastritis I have is grade 1 esophagitis – savary miller, intense enanthematous gastritis of the antrum. Can this kind cause bad breath?”

Pharmacist’s answer (by Adriana Sumi)
Gastritis, esophagitis and Gastroesophageal Reflux Disease – GERD (which you may also have), can cause bad breath both due to bacteria that cause gastritis, as well as possible infections resulting from GERD and esophagitis. Increased bad breath can be a sign of a worsening condition or an infection, which deserves to be investigated.

Other health problems, such as dental problems, sinusitis, problems in the oral cavity, can also be the cause of bad breath.

For an effective treatment against bad breath, it is necessary to identify and properly treat the cause of bad breath, as other palliative treatments will not solve the problem, they will only momentarily alleviate the odor. In addition to social problems, bad breath can be a sign of a health problem.

We recommend looking for a gastroenterologist to check the best treatment for your case.

Learn more at: bad breath

Definition GERD

Gastroesophageal Reflux Disease (GERD) is a disease characterized by the return of acid gastric juice to the esophagus, causing damage to the esophageal mucosa. Injuries caused to the esophageal mucosa are responsible for esophagitis. Heartburn is the burning sensation caused by this return of gastric acid.

According to the diagnosis of GERD, it can assume different classifications, such as physiological reflux, orthostatic reflux, supine reflux and combined reflux.

Epidemiology

Gastroesophageal Reflux Disease (GERD) has a worldwide distribution. It is estimated that in the United States 4-9% of the population suffer from GERD. Heartburn, or heartburn, is one of the main symptoms presented by patients with the disease and the detection of this symptom is accepted as a marker of the disease. Statistics show that 20-40% of people experience symptoms of heartburn. But not everyone who has heartburn or heartburn has GERD. Of this population, 20-40% have reflux disease.

In Brazil, there is a lack of precise data regarding the incidence of heartburn and GERD. A study by Oliveira et al found that symptoms of heartburn or bitterness in the mouth were present in 31.3% of the population of Pelotas, Rio Grande do Sul. A review of the medical literature pointed out that studies show that the prevalence of the disease is 10-15% in the Western world and 5% in the East.

GERD can happen at all ages, being more frequent in people over 40 years of age, affecting both men and women.

GERD Causes

Gastroesophageal Reflux Disease (GERD) is caused by the constant backflow of acidic gastric contents from the stomach into the esophagus. At the end of the esophagus there is a muscular ring, called the esophageal sphincter, which closes so that the gastric contents do not return. However, when this sphincter does not fully close or is abnormally relaxed, the acidic contents can back up and damage the esophageal mucosa.

The constant return of this content characterizes GERD. This condition gets worse when the person bends over or is lying down.

In addition, some factors may worsen this abnormal sphincter relaxation, such as smoking, diabetes , asthma , obesity , Zollinger-Ellison syndrome, connective tissue disorders such as scleroderma, among others. There are also factors (see Risk groups) that lead to an exaggerated production of acid by the stomach, such as inadequate nutrition, consumption of citrus fruits and coffee .

Pregnancy also increases the risk of GERD.

Groups of risk

Some risk factors may contribute to the onset of Gastroesophageal Reflux Disease.

Among them, food is one of the most important. Patients with inadequate nutrition make up a risk group for the disease. Some foods that should be avoided are:

– citrus fruits

– Café

– Fatty and fried foods

– Condiments and sauces

– Peppers and peppers

– Vinegar

– Soft drinks

In addition to these foods, some specific groups are at increased risk of reflux. Among them, we can highlight:

– Diabetic patients

– Obese patients

– Patients with scleroderma (a connective tissue disease)

– Patients with Zollinger-Ellison syndrome

– Patients with hiatal hernia

– Patients with delayed gastric emptying

– Pregnant women

Symptoms

The symptoms of Gastroesophageal Reflux Disease are characterized by the return of acidic content and damage to the esophageal mucosa. Among them, we can mention:

– Burning sensation in the chest (heartburn), sometimes spreading to the throat.

– Bitter taste in the mouth.

– Chest pain.

– Dry cough.

– Sore throat with inflammation.

– Regurgitation.

– Sensation of something stuck in the throat.

– Constant choking.

– Shortness of breath with wheezing.

In children, reflux can happen with the return of the contents of the breast, which can cause choking, crying, repeated sleep and predisposition to upper respiratory tract infections.

GERD can be asymptomatic, that is, without symptoms.

Gastric juices can also enter the lungs, which can lead to asthma, bronchitis or pneumonia.

Gastroesophageal reflux manifests mainly in the evening after dinner.

GERD diagnosis

The doctor will carry out a clinical investigation of the symptoms presented by the patient. If you have heartburn and constant burning that gets worse when lying down or bending over, see a doctor so he can run the proper tests.

In most cases, the diagnosis of GERD is obtained after a description of the patient’s symptoms.

Among these tests, we can mention:

– Upper digestive endoscopy (EDA): this test allows assessing the state of the mucosa and internal anatomy of the esophagus, in addition to allowing the biopsy. This exam provides results that allow the classification of esophagitis (by Savari-Miller and Los Angeles criteria) and other conditions associated with the disease.

– Biopsy and cytology exams: allows to evaluate the histology, that is, the state of the tissue of the esophagus.

– X-ray of the upper part of the digestive system: in this exam, the patient ingests a barium solution that allows the doctor to see, in the X-ray, the entire silhouette and contour of the stomach, esophagus and duodenum.

– Manometry: in this test, peristalsis is evaluated and the response of the sphincters to pressure and extent of relaxation is verified.

– 24-hour pHMetry: this test evaluates gastric pH and provides information on how long each reflux lasted, how many times it occurred and the results of it. Thus, it is possible to classify reflux as:

type of reflux

Orthostatic reflux (standing)

Supine reflux (lying down)

physiological reflux

< 8,2%

< 3,0%

orthostatic reflux

> 8,2%

< 3,0%

supine reflux

< 8,2%

> 3,0%

combined reflux

> 8,2%

< 3,0%

– Scintigraphy: in this case, the patient ingests a harmless radioactive substance that allows an image to be generated through the emitted radiation.

GERD Complications

Constant exposure of the esophagus to acid gastric juice can cause ulcerations in the esophagus, decrease in esophageal diameter caused by ulcer healing, changes in the esophageal mucosa that increase the likelihood of cancer (a condition known as Barrett’s esophagus). Caucasian men are at a higher risk of developing Barrett’s esophagus .

Another important complication is esophagitis, which appears in approximately 50% of patients with GERD. This condition can be classified as follows:

– Grade I: erythema

– Grade II: non-confluent linear erosions

– Grade III: confluent circular erosions

– Grade IV: narrowing of the esophageal lumen or Barrett’s esophagus.

Barrett’s syndrome increases the risk of developing esophageal cancer by a factor of 30 .

GERD treatments

The main treatment is medication, which most often depends on the intake of proton pump inhibitors (for example, omeprazole), decreasing the production of gastric acid.

In some cases, surgery may be required, usually performed laparoscopically.

Some drugs used are:

– Antacids: neutralize excess acid produced by the stomach. Some antacid medications are based on magnesium hydroxide and aluminum hydroxide. Other medicines are: calcium carbonate and sodium bicarbonate.

– Histamine H2 receptor blockers: reduce the amount of acid produced. Examples include: ranitidine, cimetidine, amotidine and nizatidine. The duration of action of these drugs can reach 12 hours.

– Proton pump inhibitors: they are more potent than histamine H2 inhibitors and have a longer duration of action. In this class we have omeprazole , lansoprazole, esomeprazole and rabeprazole.

– Prokinetics: these drugs increase the pressure of the esophageal sphincter and improve gastric emptying. In this class we have metoclopramide, bromopride, cisapride, erythromycin and domperidone.

The doctor can associate medications for a better clinical response of the patient. In addition, different therapeutic schemes are adopted in maintenance therapy.

Baclofen, which acts as a relaxant, is sometimes indicated in GERD with severe symptoms. This medicine is mostly prescribed by doctors in the United States.

Surgery                                                         
In some severe cases, the doctor may perform surgery on the lower esophageal sphincter (cardia). The insertion of a device (ring), called LINX, at the level of the sphincter is another possible surgical method.
However, surgery is rarely used.

GERD herbal medicine

Some medicinal plants can help control the symptoms of Gastroesophageal Reflux Disease and acid production. Some examples:

– Chamomile

– licorice

– Espinheira-santa

– Beldroega

– ginger

– Carrot

– Potato

– Alga Carolina

Tips

Some tips can help control and even prevent episodes of Gastroesophageal Reflux Disease.

– Elevate the head of the bed by about 30 degrees.

– Avoid after meals.

– Exercise regularly (if possible 30 minutes a day), the aim is primarily to lose weight, which is a risk factor for GERD1 . In fact, excess fat in the abdominal area can put pressure on the stomach and push the contents back up into the esophagus.

– Reduce alcohol and cigarette consumption.

– Follow the medical instructions correctly and always take the medication at the appropriate and indicated times.

– Be aware of the factors that trigger reflux crises and try to avoid them.

– Fighting stress , a possible cause of gastroesophageal reflux. Some relaxation techniques and regular exercise are good ways to reduce stress.

Prevention

Some tips for preventing GERD disease and episodes:

– Maintain a healthy diet. Avoid fats and excesses.

– Avoid excessive consumption of citrus fruits.

– Practice exercises, they help maintain a healthy life and control weight.

– Avoid smoking.

– Consume alcohol moderately.

– Beware of very spicy foods and exotic seasonings. They can increase stomach acid production.

– Avoid wearing very tight clothes or belts in the abdominal area.

– Be careful with the consumption of coffee and caffeinated products. This compound increases the production of gastric acid. If possible, drink no more than 2 cups of coffee, tea or soda a day.

– Do not lie down or sit right after meals.

– In some cases it is necessary to raise the pillow at bedtime, so that the head is a little higher.

– Avoid eating large amounts of food. Instead, eat small, regular meals.

– Reduce the consumption of soft drinks. They have a lot of acid and can make heartburn and GERD worse.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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