Gastroesophageal reflux disease ( GERD ), also known as acid reflux , is a long-term condition in which the contents of the stomach rise back into the resulting esophagus. in symptoms or complications. Symptoms include acidic taste in the back of the mouth, heartburn, bad breath, chest pain, vomiting, respiratory problems, and tooth loss. Complications include esophagitis, esophageal stricture, and Barrett's esophagus.
Risk factors include obesity, pregnancy, smoking, hiatus hernia, and taking certain medications. The drugs involved include antihistamines, calcium channel blockers, antidepressants, and sleeping pills. This is due to poor closure of the lower esophageal sphincter (the intersection between the stomach and the esophagus). Diagnosis among those who do not improve with more modest measures may involve gastroscopy, upper GI series, oesophageal pH monitoring, or esophageal manometry.
Treatment is usually through lifestyle changes, medications, and sometimes surgery. Lifestyle changes may include not lying down for three hours after eating, losing weight, avoiding certain foods, and quitting smoking. Medications include antacids, H 2 receptor blockers, proton pump inhibitors, and prokinetics. Surgery can be an option on those who do not improve with other actions.
In the Western world, between 10 and 20% of the population is affected by GERD. Gastroesophageal reflux (GER) occasionally, without significant symptoms or complications, is more common. This condition was first described in 1935 by American gastroenterologist Asher Winkelstein. The classic symptoms were described earlier in 1925.
Video Gastroesophageal reflux disease
Signs and symptoms
Adult
The most common GERD symptoms in adults are the acidic taste in the mouth, regurgitation, and heartburn. Less common symptoms include pain with swallowing/sore throat, increased saliva (also known as impolite water), nausea, chest pain, and cough.
GERD sometimes causes injury to the esophagus. This injury may include one or more of the following:
- Reflux esophagitis - inflammation of the esophageal epithelium that can cause ulcers near the intersection of the stomach and esophagus
- Esophageal stricture - a persistent esophageal narrowing caused by inflammation induced by reflux
- Esophagus Barrett - intestinal metaplasia (epithelial cell changes from the intestinal squamous epithelium to the intestine) of the distal esophagus
- Adenocarcinoma of the esophagus - a form of cancer
Some researchers have proposed that recurrent ear infections, and idiopathic pulmonary fibrosis may be bound, in some cases, to GERD; However, the causative role has not been established. GERD does not appear to be associated with chronic sinusitis.
Children
GERD may be difficult to detect in infants and children, as they can not describe what they feel and indicators should be observed. Symptoms can vary from typical adult symptoms. GERD in children can cause recurrent vomiting, easy spitting, coughing, and other respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling from a bottle or breast just to cry again, failure to gain enough weight, bad breath, and belching are also common. Children may have one or more symptoms; there is no single universal symptom in all children with GERD.
Of the approximately 4 million babies born in the US each year, up to 35% of them may experience difficulty with reflux in the first few months of their life, known as 'spitting'. One theory for this is the "fourth trimester theory" which records most animals born with significant mobility, but humans are relatively helpless at birth, and suggests there may be a fourth trimester, but children are born early, evolutionally, to accommodate larger head and brain development and allow them to pass through the birth canal and this leaves them with a partially undeveloped digestive system.
Most children will outperform their reflux on their first birthday. However, a small but significant number of them will not cope with the condition. This is especially true when a family history of GERD is present.
Esofagus Barrett
GERD can cause Barrett's esophagus, a type of intestinal metaplasia, which in turn is a precursor condition for esophageal cancer. The risk of development from Barrett to dysplasia is uncertain, but it is estimated to be about 20% of cases. Because the risk of chronic heartburn develops to Barrett, EGD every five years is recommended for people with chronic heartburn, or who take medication for chronic GERD.
Maps Gastroesophageal reflux disease
Cause
GERD is caused by failure of the lower esophageal sphincter. In healthy patients, the "Angle of His" - the angle at which the esophagus enters the stomach - creates a valve that prevents the duodenum bile, enzymes, and stomach acid from returning to the esophagus where they can cause burning and inflammation. sensitive esophageal tissue.
Factors that can contribute to GERD:
- Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors.
- Obesity: an increase in body mass index is associated with a more severe GERD. In a large series of 2,000 patients with symptomatic reflux disease, it has been shown that a 13% change in esophageal acid exposure is caused by changes in body mass index.
- Zollinger-Ellison syndrome, which can present with increased acidity of the stomach due to gastrin production.
- High blood calcium levels, which can increase gastrin production, leading to increased acidity.
- Scleroderma and systemic sclerosis, which may indicate oesophageal dismotility.
- The use of drugs such as prednisolone.
- Visceroptosis or GlÃÆ' Â © nard syndrome, in which the stomach has drowned in the abdomen thus disrupting the motility and secretion of gastric acid.
GERD has been associated with various respiratory and laryngeal complaints such as laryngitis, chronic cough, pulmonary fibrosis, earache, and asthma, even when not seen clinically. This atypical GERD manifestation is often referred to as laryngopharyngeal reflux (LPR) or as an esophageal reflux disease (EERD).
Factors that have been linked to GERD, but not conclusively:
- Obstructive sleep apnea
- Gallstones, which can block the flow of bile into the duodenum, which can affect the ability to neutralize stomach acid
In 1999, a review of existing studies found that, on average, 40% of GERD patients also had H. pylori infection . Eradication of H. pylori may lead to an increase in acid secretion, leading to the question whether H. pylori -Interposed GERD patients differ from uninfected GERD patients. A double-blind study, reported in 2004, found no clinically significant differences between these two types of patients with regard to subjective or objective measures of disease severity.
Diagnosis
GERD diagnosis is usually made when typical symptoms are present. Reflux may be present in asymptomatic individuals and the diagnosis requires either symptoms or complications and reflux of gastric contents.
Other tests may include esophagogastroduodenoscopy (EGD). Barium swallow X-rays should not be used for diagnosis. Esophageal manometry is not recommended for use in diagnosis, recommended only before surgery. Monitoring of ambulatory esophageal pH may be useful in those who do not improve after PPI and are not needed in those with Barrett's esophagus seen. Investigations for H. pylori are not usually necessary.
The current gold standard for GERD diagnosis is oesophageal pH monitoring. This is the most objective test for diagnosing reflux disease and allows monitoring of GERD patients in their response to medical or surgical treatment. One practice for the diagnosis of GERD is short-term treatment with proton pump inhibitors, with symptom improvement showing a positive diagnosis. Short-term treatment with a proton pump inhibitor can help predict an abnormal 24-hour pH monitoring result among patients with symptoms suggestive of GERD.
Endoscopy
Endoscopy, looking down into the abdomen with a fiber optic sphere, is not routinely required if the case is typical and responds to treatment. Recommended when people do not respond well to treatment or have alarm symptoms, including dysphagia, anemia, blood in stool (chemically detected), wheezing, weight loss, or sound changes. Some doctors recommend endoscopic once-in-a-lifetime or 5- to annual for people with long GERD, to evaluate the possibility of dysplasia or Barrett's esophagus.
Biopsy performed during gastroscopy may indicate:
- Edema and basal hyperplasia (nonspecific inflammatory change)
- Lymphocytic (nonspecific) inflammation
- Neutrophil inflammation (usually due to reflux or gastritis Helicobacter )
- Eosinophilic inflammation (usually due to reflux): The presence of intraepithelial eosinophils may indicate the diagnosis of eosinophilic esophagitis (EE) if eosinophils are present in sufficient quantities. Less than 20 eosinophils per high-power microscopic field in the distal throat, in the presence of other histologic features of GERD, are more consistent with GERD than EE.
- Cup cell metaplasia or Barrett's esophagus
- Papila elongation
- Depletion of squamous cell layer
- Dysplasia
- Carcinoma
The reflux changes may not be erosive in nature, leading to "nonerosive reflux disease".
Severity
Severity can be documented with the Johnson-DeMeester rating system: 0 - None 1 - Minimal - occasional episode 2 - Medium - 3rd visit medical therapy - Severe - interfere with daily activities
Differential diagnosis
Other causes of chest pain such as heart disease should be excluded before making a diagnosis. Another type of acid reflux, which causes respiratory and laryngeal signs and symptoms, is called laryopharyngeal reflux (LPR) or "esophageal reflux disease (EERD). Unlike GERD, LPR seldom produces heartburn, and is sometimes called silent reflux.
Treatment
Treatments for GERD include lifestyle modification, medication, and possibly surgery. Initial treatment is often with proton pump inhibitors such as omeprazole.
Lifestyle
Certain foods and lifestyles are thought to increase gastroesophageal reflux, but most dietary interventions have little supporting evidence. Avoiding certain foods and eating before lying down should be recommended only for those associated with symptoms. Foods that have been involved include coffee, alcohol, chocolate, fatty foods, sour foods, and spicy foods. Weight loss and raised head of bed are generally useful. The raised head wedge pillows can inhibit gastroesophageal reflux during sleep. Quitting smoking and not drinking alcohol does not seem to result in significant symptom improvement. Although moderate exercise can improve symptoms in people with GERD, strong exercise may aggravate it.
Drugs
The main drugs used for GERD are proton pump inhibitors, H receptor blockers and antacids with or without alginic acid.
Proton-pump inhibitors (PPIs), such as omeprazole, are the most effective, followed by H 2 receptor blockers, such as ranitidine. If once-daily PPIs are only partially effective, they can be used twice a day. They should be taken one and a half to an hour before eating. There is no significant difference between PPIs. When these drugs are used in the long run, the lowest effective dose should be taken. They can also be taken only when symptoms appear in those who are frequently experiencing problems. H 2 receptor blockers cause an increase of about 40%.
Evidence of antacids is weaker with a benefit of about 10% (NNT = 13) while the combination of antacid and alginic acids (such as Gaviscon) can improve symptoms 60% (NNT = 4). Metoclopramide (prokinetik) is not recommended either alone or in combination with other treatments because of concerns about side effects. The benefits of moskinride prokinetic is simple.
Sucralfate has an effectiveness similar to the H 2 inhibitor receptor ; however, sucralfate needs to be taken several times a day, thus limiting its use. Baclofen, a GABA receptor agonist B , although effective, has similar problems with requiring frequent doses in addition to greater adverse effects compared to other drugs.
Surgery
The standard surgical treatment for severe GERD is Nissen fundoplication. In this procedure, the upper abdomen is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux and improve the hiatus hernia. Recommended only to those who do not improve with the PPI. Quality of life is improved in the short term compared to medical therapy, but there is uncertainty in the benefits over surgery versus long-term medical management with proton pump inhibitors. When comparing different fundoplikasi techniques, posterior partial fundoplication surgery is more effective than anterior partial fundoplication surgery, and partial fundoplication has better outcomes than total fundoplication.
In 2012 the FDA approves an instrument called LINX, which consists of a series of metal beads with magnetic cores placed surgically around the lower esophageal sphincter, for those with severe symptoms that do not respond to other treatments. Increased GERD symptoms are similar to the symptoms of Nissen fundoplication, although there is no data on long-term effects. Compared with the Nissen fundoplication procedure, this procedure shows a reduction in complications such as the common bloat gas syndrome. Adverse responses include difficulty swallowing, chest pain, vomiting, and nausea. Contraindications that suggest the use of this tool are patients who may be allergic to titanium, stainless steels, nickel, or iron materials. A warning suggests that the device should not be used by patients who may be affected, or undergo, magnetic resonance imaging (MRI) due to serious injury to the patient and damage to the device.
In those with symptoms that do not improve with PPI surgery known as transitional raising fundoplations may be helpful. Benefits can last up to six years.
Pregnancy
In pregnancy, dietary modification and lifestyle changes can be tried, but often have little effect. Calcium based antacids are recommended if these changes are not effective. Antacids based on aluminum and magnesium are also safe, such as ranitidine and PPI.
Baby
Babies may see relief with changes in feeding techniques, such as smaller feeding, more frequent, changes in position during feeding, or more frequent burping during breastfeeding. They can also be treated with drugs such as roditidine or proton pump inhibitors. However, proton pump inhibitors have not been found effective in this population and there is a lack of evidence for safety.
Overtreatment
The use of acid suppression therapy is a common response to GERD symptoms and many patients get more of this kind of care than the benefits of each case. Excessive use of these treatments is a problem because of the side effects and costs that patients will have from undergoing unnecessary therapy, and patients should not take more care than they need.
In some cases, a person with GERD symptoms can manage it by taking over-the-counter medications and making lifestyle changes. It's often safer and less expensive than taking prescribed medications. Some guidelines recommend attempting to treat symptoms with H 2 antagonists before using proton pump inhibitors due to cost and safety issues.
Epidemiology
In the Western population, GERD affects about 10% to 20% of the population and a new 0.4% develops this condition. For example, about 3.4 million to 6.8 million Canadians are GERD sufferers. GERD prevalence rates in developed countries are also closely related to age, with adults aged 60 to 70 being the most frequently affected. In the United States, 20% of people experience symptoms in one week and 7% every day. No data support the sex dominance associated with GERD.
History
Outdated treatment is vagotomy ("highly selective vagotomy"), surgical removal of the vagus nerve branches that conserve the lining of the stomach. This treatment has largely been replaced by drugs. Vagotomy by itself tends to exacerbate the contraction of the gastric sphincter sphincter, and delay abdominal emptying. Historically, vagotomy was combined with pyloroplasty or gastroenterostomy to address this problem.
Research
A number of endoscopic devices have been tested to treat chronic gastritis.
- Endocinch, placing stitches in the lower esophogeal sphincter (LES) to make small folds to help strengthen the muscles. However, long-term results are disappointing, and the device is no longer sold by Bard.
- Stretta Procedure, using electrodes to apply radio frequency energy to LES. The systematic review and meta-analysis 2015 in response to a systematic review (no meta-analysis) conducted by SAGES does not support the claim that Stretta is an effective treatment for GERD. A systematic review of 2012 found that this improved the symptoms of GERD.
- NDO Surgery Plicator creates a plication, or folding, tissue near the gastroesophageal intersection, and attaches plications to a stitch-based implant. The company stopped operating in mid 2008, and the device is no longer in the market.
- Transoral incisionless fundoplication, which uses a device called Esophyx, may be effective.
See also
- Esophageal motility disorder
- Study of esophageal motility
References
External links
- Gastroesophageal reflux disease in Curlie (based on DMOZ)
- Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, Johnson SP, Allen J, Brill JV (October 2008). "Statement of Medical Position of the Association of Gastroenterology of America on the management of gastroesophageal reflux disease". Gastroenterology . 135 (4): 1383-91, 1391.e1-5. doi: 10.1053/j.gastro.2008.08.045. PMIDÃ, 18789939. Lay Summary
- Lichtenstein DR, Cash BD, Davila R, Baron TH, Adler DG, Anderson MA, Dominitz JA, Gan SI, Harrison ME, Ikenberry SO, Qureshi WA, Rajan E, Shen B , Zuckerman MJ, Fanelli RD, VanGuilder T (August 2007). "The role of endoscopy in the management of GERD". Gastrointestinal Endoscopy . 66 (2): 219-24. doi: 10.1016/j.gie.2007.05.027. PMIDÃ, 17643692. Lay Summary
- Hirano I, Richter JE (March 2007). "ACG practice guide: oesophageal reflux test" (PDF) . Am J Gastroenterol . 102 (3): 668-85. doi: 10.1111/j.1572-0241.2006.00936.x. PMIDÃ, 17335450 Ã,
Source of the article : Wikipedia
0 Comments