Description
Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backward flow of stomach acid and digestive juices into the esophagus. Lifestyle modifications play a crucial role in managing GERD, such as avoiding trigger foods, maintaining a healthy weight, and elevating the head of the bed during sleep. Dietary changes, such as reducing acidic and fatty foods, can alleviate GERD symptoms and prevent exacerbation. Over-the-counter antacids provide short-term relief by neutralizing stomach acid, but they are not a long-term solution for managing GERD. Proton pump inhibitors (PPIs) are commonly prescribed medications that reduce stomach acid production and promote healing of the esophagus. H2 receptor antagonists are another class of medications that block histamine production and decrease acid production in the stomach. Regular exercise can aid in managing GERD by promoting weight loss and improving overall digestive health. Avoiding smoking and excessive alcohol consumption is crucial, as both can worsen GERD symptoms and interfere with treatment.
Summary Listen
- Gastroesophageal reflux (GER) is a normal physiological process, while gastroesophageal reflux disease (GERD) is a spectrum of diseases causing symptoms like heartburn and acid regurgitation, and can lead to esophageal damage. GERD occurs due to failure of normal anti-reflux barriers against frequent reflux.
- Anti-reflux mechanisms include the intrinsic lower esophageal sphincter (LES), diaphragmatic crura, intra-abdominal location of the LES, frenoesophageal ligaments, and esophageal clearance mechanisms. Reflex mechanisms involve transient LES relaxation, solo-induced LES relaxation, hypotensive LES, hiatal hernia, increased gastric acid secretion, delayed gastric emptying, and duodenal gastric reflux.
- The intrinsic LES, a tonically contracted muscle, is strengthened by the diaphragmatic crura and frenoesophageal ligament. The LES maintains high pressure due to muscle tone and cholinergic neurons, with pressure varying diurnally and influenced by hormones and food.
- Esophageal clearance involves volume clearance via peristalsis and acid clearance. Saliva and esophageal gland secretions, containing bicarbonate, neutralize remaining acid. Impaired salivary gland function or esophageal dysmotility can increase reflux.
- Increased gastric acid secretion, particularly with pepsin, disrupts the mucosal barrier. The presence of an acid pocket in the upper stomach and duodenal gastric reflux can also contribute to esophageal inflammation. Tissue resistance includes pre-epithelial, epithelial, and post-epithelial defenses.
- GERD diagnosis lacks a gold standard. Empirical trials of acid suppression (PPIs) are a common initial step, followed by barium swallow if dysphagia is present. Endoscopy is crucial for those with complications or alarm symptoms. Esophageal manometry assists in LES assessment, while 24-hour pH monitoring is the gold standard for GERD diagnosis.
- Treatment goals are to eliminate symptoms, heal esophagitis, manage/prevent complications, and maintain remission. Lifestyle modifications include head-end elevation, loose clothing, weight loss, and dietary changes. Pharmacological options are antacids, prokinetics, H2 blockers, and PPIs.
- Surgical treatment, primarily Nissen fundoplication, is indicated for medication-refractory GERD or severe complications, increasing LES pressure and decreasing transient LES relaxation. Endoscopic treatments, like radiofrequency energy delivery or endoscopic plication, offer minimally invasive alternatives.
- Complications of untreated GERD include ulcers, hemorrhage, perforation, peptic strictures, and Barrett's esophagus. Peptic strictures cause dysphagia and can be dilated. Barrett's esophagus involves metaplasia of the esophageal lining and carries an increased risk of adenocarcinoma. Surveillance and ablation are crucial in managing Barrett's.
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About the Speakers
DR.SHADIYA C
Medical gastroenterology Consultant, GEM hospital, Coimbatore
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