Reflux Disease

reflux disease

When acid from the stomach leaks up into the gullet (esophagus) it is called as acid reflux. It is also known to cause heartburn and other symptoms. It is treated by drugs, which reduce the amount of acid made in your stomach, known as antacids.

What is the function of gastrointestinal system in our body and how does it function?

When food is eaten it passes down from the mouth to the food pipe also known as esophagus (gullet) and then into the stomach. Stomach is lined by cells, which secrete acid, helping in food digestion. On the other hand stomach protects itself from acids by another group of cells, which secrete mucus, thus preventing the stomach from dangerous acid. The cells in the esophagus are different and they don’t have this protection from acid.

The circular band of muscle (called as 'sphincter') is present at the junction between the esophagus and stomach. It behaves like a valve, relaxing when food is taken in, and tightens to prevent food and acid leaking back up (refluxing) into the esophagus.

What do you understand by Oesophagitis?

Oesophagitis means inflammation of the lining of the oesophagus. The main cause is due to reflux of stomach acid which irritates the inside lining of the oesophagus. As the lining of the oesophagus cannot protect itself from acid it is more prone to cause inflammation. Some people are more sensitive than others to develop esophagitis. Therefore, some people develop symptoms with only a small amount of reflux.

What is GERD?

Gastro-esophageal reflux disease (GERD)is chronic symptomatic condition caused because ofesophageal mucosal damage because of stomach acid coming up into the esophagus .

How do they present?

The main symptoms are heartburn, which is a burning feeling which rises from the upper abdomen or lower chest up towards the neck. (It is confusing, as it has nothing to do with the heart!)

Other common symptoms include: pain in the upper abdomen and chest, nausea/feeling sick, an acid taste in the mouth, bloating, belching, and a burning pain when you swallow hot drinks. These symptoms come and go.

Some uncommon symptoms includea persistent cough particularly at night, asthma symptoms of cough and wheeze, gum problems, bad breath, sore throat, hoarseness, and a feeling of a lump in the throat. Severe chest pain develops in some cases (and may be mistaken for a heart attack).

What are the main cause of developing reflux esophagitis?

The main cause of reflux is a faulty sphincter at the bottom of the oesophagus, which normally prevents acid reflux. The main reason is not known, but in some cases the pressure in the stomach is higher than the sphincter can withstand. For example, during pregnancy, or after a large meal, or when bending forward. In conditions like hiatus hernia (when part of the stomach protrudes into the chest through the diaphragm), there is an increased chance of developing reflux.

Most people have heartburn at some time, perhaps after a large meal. However, about 1 in 3 adults have some heartburn every few days, and nearly 1 in 10 adults have heartburn at least once a day. In many cases it is mild and soon passes. However, it is quite common for symptoms to be frequent or severe enough to affect quality of life. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, the overweight, and those aged between 35 and 64.

What tests are recommended?

Tests are usually not required with typical symptoms. Tests are advised if symptoms: are severe, or do not improve with treatment, or are not typical of GERD.

Endoscopy is the common test. This is where a thin, flexible fibreoptic scope is passed down from the mouth into the oesophagus and into the stomach. By doing this the doctor or nurse can to look inside thoroughly. If the patient has esophagitis, the lower part of the oesophagus looks red and inflamed. However, if it looks normal it does not rule out acid reflux. Some people are very sensitive to small amounts of acid, and can have symptoms with little or no inflammation to see.

Two terms have been recognized after endoscopy, these are: Oesophagitis, when the oesophagus can be seen to be inflamed and Endoscopy-negative reflux disease when there are typical symptoms but endoscopy is normal.

A test to check the acidity inside the oesophagus may be done if the diagnosis is not clear.Other tests such as heart tracings, chest X-ray, etc, may be done to rule out other conditions if the symptoms are not typical.

How do you prevent it?

Common things to prevent this would be a lifestyle change, though there is little research to prove how well this works-

  • Stop Smoking as chemicals from cigarettes relax the sphincter muscle.
  • Some foods and drinks known to cause reflux disease should be avoided. Foods and drinks that have been suspected of making symptoms worse in some people include: peppermint, tomatoes, chocolate, spicy foods, hot drinks, coffee, and alcoholic drinks. Also, avoiding large volume meals may help.
  • Some drugs may make symptoms worse as they irritate the oesophagus, or relax the sphincter muscle and make acid reflux more likely. The most common culprits are anti-inflammatory painkillers (such as ibuprofen or aspirin). Others include: diazepam, theophylline, nitrates, and calcium channel blockers such as nifedipine. But this is not an exhaustive list. Tell a doctor if you suspect that a drug is causing the symptoms, or making symptoms worse.
  • Try loosing Weight if you are overweight
  • Improve posture. Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach, which may make any reflux worse.
  • At Bedtime, if symptoms recur most nights, the following may help, go to bed with an empty, dry stomach. To do this, don't eat in the last three hours before bedtime, and don't drink in the last two hours before bedtime. If you are able; try raising the head of the bed by 10-20 cms (for example, with books or bricks under the bed's legs). This helps gravity to keep acid from refluxing into the oesophagus. If you do this do not use additional pillows, because this may increase abdominal pressure.
How do you treat it?

Treatment with drugs includes taking, antacids (which neutralize acid in the stomach), Acid-suppressing drugs (proton pump inhibitors (PPIs) and histamine receptor blockers)they prevent acid secretion in stomach, Prokinetic drugs (which speed up passage of food through stomach)

An operation can 'tighten' the lower oesophagus to prevent acid leaking up from the stomach. It can be done by 'keyhole' surgery. In general, the success of surgery is no better than acid-suppressing medication. However, surgery may be an option for some people whose quality of life remains significantly affected by their condition and where drug treatment is not working well or not wanted long-term.

What are the complications of Oesophagitis?,

Complication of regular reflux disease would be strictures, due to severe and long-standing inflammation causing scarring and narrowing (a stricture) of the lower oesophagus. This is uncommon. Barrett’s oesophagus is a condition in which due to regular exposure of acid to cells that line the lower oesophagus they change, becoming more prone than usual to become cancerous. (About 1 or 2 people in 100 with Barrett's oesophagus develop cancer of the oesophagus).The risk of developing cancer of the oesophagus is slightly increased compared to the normal risk if you have long-term acid reflux. It has to be stressed that most people with reflux do not develop any of these complications. Its wise to tell your doctor if you have pain or difficulty (food 'sticking') when you swallow which may be the first symptom of a complication.

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