विवरण
Gastroesophageal reflux disease (GERD) is a digestive disorder that occurs when stomach acid flows back into the esophagus, causing heartburn and other symptoms. GERD can cause damage to the esophagus, pharynx, or respiratory tract if left untreated. Symptoms of GERD include heartburn, regurgitation of sour or bitter liquid, difficulty swallowing, and chest pain. A diagnosis of GERD starts with a physical examination and a description of symptoms and medical history. Treatment for GERD includes lifestyle changes such as losing weight, avoiding alcohol and tobacco, and avoiding large meals before bedtime. Medications such as antacids, H2 blockers, and proton pump inhibitors can also help relieve symptoms. In severe cases, surgery may be necessary.
सारांश
- Gastroesophageal reflux disease (GERD) affects approximately 20% of the population and is a common ailment. Patients typically complain of "gas" and "acidity," which encompasses symptoms like repetitive burping, excessive flatulence, abdominal bloating, epigastric pain, and heartburn. These symptoms can significantly lower quality of life, causing social embarrassment and limiting daily activities.
- Risk factors for GERD include obesity, sedentary lifestyles, and certain activities that increase abdominal pressure, such as weightlifting. Dietary factors like chocolate, coffee, alcohol, and carbonated drinks can reduce lower esophageal sphincter (LES) pressure, contributing to reflux. Disrupted sleep patterns, anxiety, stress, and respiratory diseases with excessive coughing are also contributing factors.
- The pathophysiology of GERD involves a reduced baseline pressure in the LES, allowing gastric contents to reflux into the esophagus. The esophageal lining, composed of sensitive squamous epithelium, becomes irritated by stomach acid, leading to heartburn and other symptoms. This can also cause esophageal hypersensitivity, triggering symptoms even without active reflux.
- GERD can manifest in various ways, including regurgitation, belching, a bitter taste in the mouth, halitosis, sore throat, hoarseness, chest tightness, asthma symptoms, and a feeling of something stuck in the throat. Potential complications of GERD include esophagitis, Barrett's esophagus, and, rarely, esophageal adenocarcinoma.
- Endoscopy is indicated in patients with red flag signs like dysphagia, odynophagia, weight loss, and blood in vomitus. It is also recommended for patients with GERD symptoms lasting more than five years to rule out Barrett's metaplasia. Endoscopic findings can reveal esophagitis, Barrett's esophagus characterized by columnar epithelium, and peptic structures or esophageal webs.
- Management of GERD involves lifestyle modifications such as weight loss, avoiding trigger foods and drinks, remaining upright after meals, and avoiding activities that increase abdominal pressure. Medical treatment typically includes a high-dose proton pump inhibitor (PPI) for at least 60 days. Long-term PPI use can lead to deficiencies in protein, vitamin B12, folate, and calcium, increasing the risk of osteoporosis and anemia.
- Prokinetic agents like etopride and lesoride can be used for short-term symptom relief, while domperidone is reserved for severe nausea and vomiting. Sodium alginate, like Gaviscon, forms a protective gel layer over stomach acid and is most effective when used on an as-needed basis, and not in conjunction with PPIs, as they raise the pH. Fundo plication, performed laparoscopically or endoscopically, reinforces the LES to prevent reflux, though it carries a risk of dysphagia if the pressure increases excessively.
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