GASTROESOPHAGEAL REFLUX DISEASE.

Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease

Introduction

Gastroesophageal reflux disease (GERD) is defined as the reflux of acid-rich stomach contents into the esophagus, burning the inner layer of the esophagus and causing symptoms that are sufficient to interfere with quality of life (Kaltenbach, Crockett & Gerson, 2006). GERD is one of the most common causes for primary care physician visits and a leading cause of noncardiac chest pain. Symptoms of GERD include heartburn, a burning sensation felt in the chest, foul-smelling breath, and cough. Other symptoms include wheezing, hoarseness, and recurrent respiratory infections. Complicated GERD may cause esophagitis, permanent scarring of the esophagus, and even precancerous transformation of the esophageal lining.

A competent lower esophageal sphincter (LES) is needed to prevent GERD. (Freston, 2001) The length of intra-abdominal esophagus, the strength of the circular muscle fibbers at the LES, and the normal emptying function of the stomach dictate LES strength. Acid production is also an important factor in the symptoms of GERD.

Acid reflux, also known as gastroesophageal reflux disease (GERD) or chronic heartburn, is a medical condition characterized by abnormal backflow of acid from the stomach to the esophagus. It is one of the most common disorders of the gastrointestinal tract and it is estimated that 3 to 4 percent of the population has GERD, while up to 40 percent of the population experience heartburn, the most common symptom associated with GERD, at least once a month. The various causes of acid reflux generally lead to the same symptoms and can be diagnosed through a careful patient history and some diagnostic exams. Treatment ranges from conservative management through lifestyle changes, to the use of medications and potentially to surgery. Possible complications from untreated acid reflux include Barrett's esophagus and esophageal cancer.

In normal individuals, acid is secreted in the stomach to aid in the digestion of food. This acid is usually kept in the stomach and prevented from flowing backward into the esophagus by a zone of constricting muscles called the lower esophageal sphincter (LES). The strength of the LES is also supported anatomically by the muscles of diaphragm. Generally speaking, acid reflux occurs when the LES fails to keep acid and stomach contents from refluxing into the esophagus. The various causes of acid reflux fall into two general categories: decreased strength or tone of the LES and increased stomach filling.

Decreased LES tone is associated with pregnancy, smoking, certain drugs (anticholinergic drugs and ...