Tuesday, May 3, 2016

Heartburn and gastro-oesophageal reflux disease (GORD)

Heartburn and gastro-oesophageal reflux disease (GORD)

Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet).
It usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. Read more about the causes of GORD.
GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. It may just be an occasional nuisance for some people, but for others it can be a severe, lifelong problem.
GORD can often be controlled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed.This topic focuses on GORD in adults.

Symptoms of GORD can include:

  • heartburn (an uncomfortable burning sensation in the chest that often occurs after eating)
  • acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sour taste)
  • oesophagitis (a sore, inflamed oesophagus)
  • bad breath
  • bloating and belching
  • feeling or being sick
  • pain when swallowing and/or difficulty swallowing

Wednesday, June 13, 2012

What Is Acid Reflux Disease?

What Is Acid Reflux Disease?

At the entrance to your stomach is a valve, which is a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. If the LES doesn't close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus. This can cause symptoms such as a burning chest pain called heartburn. If acid reflux symptoms happen more than twice a week, you have acid reflux disease, also known as gastroesophageal reflux disease (GERD).

What causes acid reflux disease?

One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in our stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease.

These are other common risk factors for acid reflux disease:

* Eating large meals or lying down right after a meal
* Being overweight or obese
* Eating a heavy meal and lying on your back or bending over at the waist
* Snacking close to bedtime
* Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
* Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
* Smoking
* Being pregnant
* Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications
Acid Reflux Disease

Tuesday, October 18, 2011

Gastroesophageal / Acid Reflux Disease At A Glance

Gastroesophageal / Acid Reflux Disease At A Glance

* Gastroesophageal / Acid Reflux Disease is a condition in which the acidified liquid contents of the stomach backs up into the esophagus.

* The causes of GERD include an abnormal lower esophageal sphincter, hiatal hernia, abnormal esophageal contractions, and slow emptying of the stomach.

* Gastroesophageal / Acid Reflux Disease may damage the lining of the esophagus, thereby causing inflammation (esophagitis), although usually it does not.

* The symptoms of uncomplicated GERD are heartburn, regurgitation, and nausea.

* Complications of GERD include ulcers and strictures of the esophagus, Barrett's esophagus, cough and asthma, throat and laryngeal inflammation, inflammation and infection of the lungs, and collection of fluid in the sinuses and middle ear.

* Barrett's esophagus is a pre-cancerous condition that requires periodic endoscopic surveillance for the development of cancer.

* Gastroesophageal / Acid Reflux Disease may be diagnosed or evaluated by a trial of treatment, endoscopy, biopsy, x-ray, examination of the throat and larynx, 24 hour esophageal acid testing, esophageal motility testing, emptying studies of the stomach, and esophageal acid perfusion.

* GERD is treated with life-style changes, antacids, histamine antagonists (H2 blockers), proton pump inhibitors (PPIs), pro-motility drugs, foam barriers, surgery, and endoscopy.

Tuesday, October 11, 2011

What is a reasonable approach to the management of Gastroesophageal / Acid Reflux Disease?

What is a reasonable approach to the management of Gastroesophageal / Acid Reflux Disease?

There are several ways to approach the evaluation and management of Gastroesophageal / Acid Reflux Disease. The approach depends primarily on the frequency and severity of symptoms, the adequacy of the response to treatment, and the presence of complications.

For infrequent heartburn, the most common symptom of Gastroesophageal / Acid Reflux Disease, life-style changes and an occasional antacid may be all that is necessary. If heartburn is frequent, daily non-prescription-strength (over-the-counter) H2 antagonists may be necessary. A foam barrier also can be used with the antacid or H2 antagonist.

If life-style changes and antacids, non-prescription H2 antagonists, and a foam barrier do not adequately relieve heartburn, it is time to see a physician for further evaluation and to consider prescription-strength drugs. The evaluation by the physician should include an assessment for possible complications of GERD based on the presence of such symptoms or findings as:

* cough,
* asthma,
* hoarseness,
* sore throat,
* difficulty swallowing,
* unexplained lung infections, or
* anemia (due to bleeding from esophageal inflammation or ulceration).

Clues to the presence of diseases that may mimic Gastroesophageal / Acid Reflux Disease, such as gastric or duodenal ulcers and esophageal motility disorders, should be sought.

If there are no symptoms or signs of complications and no suspicion of other diseases, a therapeutic trial of acid suppression with H2 antagonists often is used. If H2 antagonists are not adequately effective, a second trial, with the more potent PPIs, can be given. Sometimes, a trial of treatment begins with a PPI and skips the H2 antagonist. If treatment relieves the symptoms completely, no further evaluation may be necessary and the effective drug, the H2 antagonist or PPI, is continued. As discussed previously, however, there are potential problems with this commonly used approach, and some physicians would recommend a further evaluation for almost all patients they see.

If at the time of evaluation, there are symptoms or signs that suggest complicated Gastroesophageal / Acid Reflux Disease or a disease other than GERD or if the relief of symptoms with H2 antagonists or PPIs is not satisfactory, a further evaluation by endoscopy (EGD) definitely should be done.

There are several possible results of endoscopy and each requires a different approach to treatment. If the esophagus is normal and no other diseases are found, the goal of treatment simply is to relieve symptoms. Therefore, prescription strength H2 antagonists or PPIs are appropriate. If damage to the esophagus (esophagitis or ulceration) is found, the goal of treatment is healing the damage. In this case, PPIs are preferred over H2 antagonists because they are more effective for healing.

If complications of Gastroesophageal / Acid Reflux Disease, such as stricture or Barrett's esophagus are found, treatment with PPIs also is more appropriate. However, the adequacy of the PPI treatment probably should be evaluated with a 24-hour pH study during treatment with the PPI. (With PPIs, although the amount of acid reflux may be reduced enough to control symptoms, it may still be abnormally high. Therefore, judging the adequacy of suppression of acid reflux by only the response of symptoms to treatment is not satisfactory.) Strictures may also need to be treated by endoscopic dilatation (widening) of the esophageal narrowing. With Barrett's esophagus, periodic endoscopic examination should be done to identify pre-malignant changes in the esophagus.

If symptoms of GERD do not respond to maximum doses of PPI, there are two options for management. The first is to perform 24-hour pH testing to determine whether the PPI is ineffective or if a disease other than Gastroesophageal / Acid Reflux Disease is likely to be present. If the PPI is ineffective, a higher dose of PPI may be tried. The second option is to go ahead without 24 hour pH testing and to increase the dose of PPI. Another alternative is to add another drug to the PPI that works in a way that is different from the PPI, for example, a pro-motility drug or a foam barrier. If necessary, all three types of drugs can be used. If there is not a satisfactory response to this maximal treatment, 24 hour pH testing should be done.

Who should consider surgery or, perhaps, an endoscopic treatment trial for GERD? (As mentioned previously, the effectiveness of the recently developed endoscopic treatments remains to be determined.) Patients should consider surgery if they have regurgitation that cannot be controlled with drugs. This recommendation is particularly important if the regurgitation results in infections in the lungs or occurs at night when aspiration into the lungs is more likely. Patients also should consider surgery if they require large doses of PPI or multiple drugs to control their reflux. Still, it is debated whether or not a desire to be free of the need to take life-long drugs to prevent symptoms of Gastroesophageal / Acid Reflux Disease is by itself a satisfactory reason for having surgery.

Tuesday, October 4, 2011

How is Gastroesophageal / Acid Reflux Disease treated?

How is Gastroesophageal / Acid Reflux Disease treated?

Life-style changes

One of the simplest treatments for Gastroesophageal / Acid Reflux Disease is referred to as life-style changes, a combination of several changes in habit, particularly related to eating.

As discussed above, reflux of acid is more injurious at night than during the day. At night, when individuals are lying down, it is easier for reflux to occur. The reason that it is easier is because gravity is not opposing the reflux, as it does in the upright position during the day. In addition, the lack of an effect of gravity allows the refluxed liquid to travel further up the esophagus and remain in the esophagus longer. These problems can be overcome partially by elevating the upper body in bed. The elevation is accomplished either by putting blocks under the bed's feet at the head of the bed or, more conveniently, by sleeping with the upper body on a wedge. These maneuvers raise the esophagus above the stomach and partially restore the effects of gravity. It is important that the upper body and not just the head be elevated. Elevating only the head does not raise the esophagus and fails to restore the effects of gravity.

Elevation of the upper body at night generally is recommended for all patients with Gastroesophageal / Acid Reflux Disease. Nevertheless, most patients with GERD have reflux only during the day and elevation at night is of little benefit for them. It is not possible to know for certain which patients will benefit from elevation at night unless acid testing clearly demonstrates night reflux. However, patients who have heartburn, regurgitation, or other symptoms of GERD at night are probably experiencing reflux at night and definitely should use upper body elevation. Reflux also occurs less frequently when patients lie on their left rather than their right sides.

Gastroesophageal / Acid Reflux Disease Diet

Several changes in eating habits can be beneficial in treating GERD. Reflux is worse following meals. This probably is so because the stomach is distended with food at that time and transient relaxations of the lower esophageal sphincter are more frequent. Therefore, smaller and earlier evening meals may reduce the amount of reflux for two reasons. First, the smaller meal results in lesser distention of the stomach. Second, by bedtime, a smaller and earlier meal is more likely to have emptied from the stomach than is a larger one. As a result, reflux is less likely to occur when patients with Gastroesophageal / Acid Reflux Disease lie down.

Certain foods are known to reduce the pressure in the lower esophageal sphincter and thereby promote reflux. These foods should be avoided and include:

* chocolate,
* peppermint,
* alcohol, and
* caffeinated drinks.

Fatty foods (which should be decreased) and smoking (which should be stopped) also reduce the pressure in the sphincter and promote reflux.

In addition, patients with Gastroesophageal / Acid Reflux Disease may find that other foods aggravate their symptoms. Examples are spicy or acid-containing foods, like citrus juices, carbonated beverages, and tomato juice. These foods should also be avoided.

One novel approach to the treatment of Gastroesophageal / Acid Reflux Disease is chewing gum. Chewing gum stimulates the production of more bicarbonate-containing saliva and increases the rate of swallowing. After the saliva is swallowed, it neutralizes acid in the esophagus. In effect, chewing gum exaggerates one of the normal processes that neutralizes acid in the esophagus. It is not clear, however, how effective chewing gum actually is in treating heartburn. Nevertheless, chewing gum after meals is certainly worth a try.

Saturday, September 24, 2011

What are the complications of Gastroesophageal / Acid Reflux Disease?

What are the complications of Gastroesophageal / Acid Reflux Disease?


The liquid from the stomach that refluxes into the esophagus damages the cells lining the esophagus. The body responds in the way that it usually responds to damage, which is with inflammation (esophagitis). The purpose of inflammation is to neutralize the damaging agent and begin the process of healing. If the damage goes deeply into the esophagus, an ulcer forms. An ulcer is simply a break in the lining of the esophagus that occurs in an area of inflammation. Ulcers and the additional inflammation they provoke may erode into the esophageal blood vessels and give rise to bleeding into the esophagus.

Occasionally, the bleeding is severe and may require:

* blood transfusions,
* an endoscopic procedure (in which a tube is inserted through the mouth into the esophagus to visualize the site of bleeding and to stop the bleeding), or
* surgical treatment.


Ulcers of the esophagus heal with the formation of scars (fibrosis). Over time, the scar tissue shrinks and narrows the lumen (inner cavity) of the esophagus. This scarred narrowing is called a stricture. Swallowed food may get stuck in the esophagus once the narrowing becomes severe enough (usually when it restricts the esophageal lumen to a diameter of one centimeter). This situation may necessitate endoscopic removal of the stuck food. Then, to prevent food from sticking, the narrowing must be stretched (widened). Moreover, to prevent a recurrence of the stricture, reflux also must be prevented.

Barrett's esophagus

Long-standing and/or severe Gastroesophageal / Acid Reflux Disease causes changes in the cells that line the esophagus in some patients. These cells are pre-cancerous and finally become cancerous. This condition is referred to as Barrett's esophagus and occurs in approximately 10% of patients with GERD. The type of esophageal cancer associated with Barrett's esophagus (adenocarcinoma) is increasing in frequency. It is not clear why some patients with Gastroesophageal / Acid Reflux Disease develop Barrett's esophagus, but most do not.

Barrett's esophagus can be recognized visually at the time of an endoscopy and confirmed by microscopic examination of biopsies of the lining cells. Then, patients with Barrett's esophagus may require periodic surveillance endoscopies with biopsies. The purpose of surveillance is to detect pre-cancerous changes so that cancer-preventing treatment can be started. It is also believed that patients with Barrett's esophagus should receive maximum treatment for Gastroesophageal / Acid Reflux Disease to prevent further damage to the esophagus. Procedures are being studied that remove the abnormal lining cells. Several endoscopic, non-surgical techniques can be used to remove the cells. These techniques are attractive because they do not require surgery; however, there are associated complications, and the long-term effectiveness of the treatments has not yet been determined. Surgical removal of the esophagus is always an option. For more, please read the Barrett's Esophagus article.
Cough and asthma

Many nerves are in the lower esophagus. Some of these nerves are stimulated by the refluxed acid, and this stimulation results in pain (usually heartburn). Other nerves that are stimulated do not produce pain. Instead, they stimulate yet other nerves that provoke coughing. In this way, refluxed liquid can cause coughing without ever reaching the throat! In a similar manner, reflux into the lower esophagus can stimulate esophageal nerves that connect to and can stimulate nerves going to the lungs. These nerves to the lungs then can cause the smaller breathing tubes to narrow, resulting in an attack of asthma.
Gastroesophageal / Acid Reflux Disease is a common cause of unexplained coughing. Although GERD also may be a cause of asthma, it is more likely that it precipitates asthmatic attacks in patients who already have asthma. Although chronic cough and asthma are common ailments, it is not clear just how often they are aggravated or caused by GERD.

Inflammation of the throat and larynx

If refluxed liquid gets past the upper esophageal sphincter, it can enter the throat (pharynx) and even the voice box (larynx). The resulting inflammation can lead to a sore throat and hoarseness. As with coughing and asthma, it is not clear just how commonly GERD is responsible for otherwise unexplained inflammation of the throat and larynx.

Inflammation and infection of the lungs

Refluxed liquid that passes the larynx can enter the lungs. The reflux of liquid into the lungs (called aspiration) often results in coughing and choking. Aspiration, however, can also occur without producing these symptoms. With or without these symptoms, aspiration may lead to infection of the lungs and result in pneumonia. This type of pneumonia is a serious problem requiring immediate treatment. When aspiration is unaccompanied by symptoms, it can result in a slow, progressive scarring of the lungs (pulmonary fibrosis) that can be seen on chest x-rays. Aspiration is more likely to occur at night because that is when the processes (mechanisms) that protect against reflux are not active and the coughing reflex that protects the lungs also is not active.

Fluid in the sinuses and middle ears

The throat communicates with the nasal passages. In small children, two patches of lymph tissue, called the adenoids, are located where the upper part of the throat joins the nasal passages. The passages from the sinuses and the tubes from the middle ears (Eustachian tubes) open into the rear of the nasal passages near the adenoids. Refluxed liquid that enters the upper throat can inflame the adenoids and cause them to swell. The swollen adenoids then can block the passages from the sinuses and the Eustachian tubes. When the sinuses and middle ears are closed off from the nasal passages by the swelling of the adenoids, fluid accumulates within them. This accumulation of fluid can lead to discomfort in the sinuses and ears. Since the adenoids are prominent in young children, and not in adults, this fluid accumulation in the ears and sinuses is seen in children and not adults.
Acid Reflux Disease

Saturday, August 14, 2010

Who Needs Gastroesophageal / Acid Reflux Disease Treatment?

Who Needs Gastroesophageal / Acid Reflux Disease Treatment?

There are many good reasons to treat Gastroesophageal / Acid Reflux Disease. First, GERD treatment makes you feel better. Living with uncontrolled GERD -- the pain, the cough, the sleepless nights -- can be tough.

Gastroesophageal / Acid Reflux Disease puts quite a burden on a person’s quality of life,” says Goutham Rao, MD. Rao is a board member of the National Heartburn Alliance and an associate professor at the University of Pittsburgh School of Medicine. “GERD,” he says, “can be truly debilitating.”

Second, GERD / Acid Reflux Disease poses some serious long-term health risks. Over time, the damage to the esophagus can cause complications. One of those is a condition called Barrett’s esophagus, which is associated with a small but significant risk of esophageal cancer. Fortunately, GERD / Acid Reflux Disease treatment can prevent Barrett’s esophagus from developing.

How do you know if you need treatment for Gastroesophageal / Acid Reflux Disease? What’s the difference between harmless heartburn and more serious GERD? It’s not so much the severity, experts say, but the frequency.

The usual recommendation is that anyone with symptoms two or more times a week should see a doctor. Cheskin is more cautious. He says that even symptoms that occur just once a week should be checked out. “Over the years,” he says, “even that level of heartburn can cause damage.”

Sometimes the most obvious sign of trouble is how often you use over-the-counter (OTC) treatments for heartburn relief.
Acid Reflux Disease