ACID REFLUX DISEASE

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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

How is acid reflux disease diagnosed?


How is acid reflux disease diagnosed?

It's time to see your doctor if you have acid reflux symptoms two or more times a week or if medications don't bring lasting relief. Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acid-blocking medications help reduce these symptoms.

If these steps don't help or if you have frequent or severe acid reflux disease symptoms, your doctor may order tests to confirm a diagnosis and check for other problems. You may need one or more tests such as these:

* Barium swallow (esophagram) can check for ulcers or a narrowing of the esophagus. You first swallow a solution to help structures show up on an X-ray.
* Esophageal manometry can check the function of the esophagus and lower esophageal sphincter.
* pH monitoring can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for one to two days to measure the amount of acid in your esophagus.
* Endoscopy can check for problems in your esophagus or stomach. This test involves inserting a long, flexible, lighted tube down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable.
* A biopsy may be takenduring endoscopy to check samples of tissue under a microscope for infection or abnormalities.
acid reflux disease
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What are the symptoms of acid reflux disease?

What are the symptoms of acid reflux disease?

Common symptoms of acid reflux are:

* Heartburn -- a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat
* Regurgitation -- a sour or bitter-tasting acid backing up into your throat or mouth

Other symptoms of acid reflux disease include:

* Bloating
* Bloody or black stools or bloody vomiting
* Burping
* Dysphagia -- a narrowing of your esophagus, which creates the sensation of food being stuck in your throat
* Hiccups that don't let up
* Nausea
* Weight loss for no known reason
* Wheezing, dry cough, hoarseness, or chronic sore throat
Acid Reflux Disease.
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What are the symptoms of uncomplicated Gastroesophageal Reflux Disease ?
















What are the symptoms of uncomplicated Gastroesophageal Reflux Disease ?

The symptoms of uncomplicated Gastroesophageal Reflux Disease are primarily heartburn, regurgitation, and nausea. Other symptoms occur when there are complications of GERD and will be discussed with the complications.

Heartburn

When acid refluxes back into the esophagus in patients with Gastroesophageal / Acid Reflux Disease, nerve fibers in the esophagus are stimulated. This nerve stimulation results most commonly in heartburn, the pain that is characteristic of GERD / Acid Reflux Disease. Heartburn usually is described as a burning pain in the middle of the chest. It may start high in the abdomen or may extend up into the neck. In some patients, however, the pain may be sharp or pressure-like, rather than burning. Such pain can mimic heart pain (angina). In other patients, the pain may extend to the back.

Since acid reflux is more common after meals, heartburn is more common after meals. Heartburn is also more common when individuals lie down because without the effects of gravity, reflux occurs more easily, and acid is returned to the stomach more slowly. Many patients with Gastroesophageal / Acid Reflux Disease are awakened from sleep by heartburn.

Episodes of heartburn may occur infrequently or frequently, but episodes tend to happen periodically. This means that the episodes are more frequent or severe for a period of several weeks or months, and then they become less frequent or severe or even absent for several weeks or months. This periodicity of symptoms provides the rationale for intermittent treatment in patients with Gastroesophageal / Acid Reflux Disease who do not have esophagitis. Nevertheless, heartburn is a life-long problem, and it almost always returns.

Regurgitation

Regurgitation is the appearance of refluxed liquid in the mouth. In most patients with GERD, usually only small quantities of liquid reach the esophagus, and the liquid remains in the lower esophagus. Occasionally in some patients with GERD, larger quantities of liquid, sometimes containing food, are refluxed and reach the upper esophagus.

At the upper end of the esophagus is the upper esophageal sphincter (UES). The UES is a circular ring of muscle that is very similar in its actions to the LES. That is, the UES prevents esophageal contents from backing up into the throat. When small amounts of refluxed liquid and/or foods breach (get through) the UES and enter the throat, there may be an acid taste in the mouth. If larger quantities breach the UES, patients may suddenly find their mouths filled with the liquid or food. What's more, frequent or prolonged regurgitation can lead to acid-induced erosions of the teeth.

Nausea

Nausea is uncommon in Gastroesophageal /Acid Reflux Disease. In some patients, however, it may be frequent or severe and may result in vomiting. In fact, in patients with unexplained nausea and/or vomiting, GERD is one of the first conditions to be considered. It is not clear why some patients with GERD develop mainly heartburn and others develop mainly nausea.
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What causes Gastroesophageal Reflux Disease?

What causes Gastroesophageal Reflux Disease?

The cause of Gastroesophageal / Acid Reflux Disease is complex. There probably are multiple causes, and different causes may be operative in different individuals, or even in the same individual at different times. A small number of patients with GERD produce abnormally large amounts of acid, but this is uncommon and not a contributing factor in the vast majority of patients. The factors that contribute to Gastroesophageal Reflux Disease are the lower esophageal sphincter, hiatal hernias, esophageal contractions, and emptying of the stomach.

Lower esophageal sphincter

The action of the lower esophageal sphincter (LES) is perhaps the most important factor (mechanism) for preventing reflux. The esophagus is a muscular tube that extends from the lower throat to the stomach. The LES is a specialized ring of muscle that surrounds the lower-most end of the esophagus where it joins the stomach. The muscle that makes up the LES is active most of the time. This means that it is contracting and closing off the passage from the esophagus into the stomach. This closing of the passage prevents reflux. When food or saliva is swallowed, the LES relaxes for a few seconds to allow the food or saliva to pass from the esophagus into the stomach, and then it closes again.

Several different abnormalities of the LES have been found in patients with Gastroesophageal / Acid Reflux Disease. Two of them involve the function of the LES. The first is abnormally weak contraction of the LES, which reduces its ability to prevent reflux. The second is abnormal relaxations of the LES, called transient LES relaxations. They are abnormal in that they do not accompany swallows and they last for a long time, up to several minutes. These prolonged relaxations allow reflux to occur more easily. The transient LES relaxations occur in patients with GERD most commonly after meals when the stomach is distended with food. Transient LES relaxations also occur in individuals without GERD, but they are infrequent.

The most recently-described abnormality in patients with Gastroesophageal / Acid Reflux Disease is laxity of the LES. Specifically, similar distending pressures open the LES more in patients with GERD than in individuals without GERD. At least theoretically, this would allow easier opening of the LES and/or greater backward flow of acid into the esophagus when the LES is open.

Hiatal hernia

Hiatal hernias contribute to reflux, although the way in which they contribute is not clear. A majority of patients with Gastroesophageal Reflux Disease have hiatal hernias, but many do not. Therefore, it is not necessary to have a hiatal hernia in order to have GERD. Moreover, many people have hiatal hernias but do not have Gastroesophageal / Acid Reflux Disease. It is not known for certain how or why hiatal hernias develop.

Normally, the LES is located at the same level where the esophagus passes from the chest through the diaphragm and into the abdomen. (The diaphragm is a muscular, horizontal partition that separates the chest from the abdomen.) When there is a hiatal hernia, a small part of the upper stomach that attaches to the esophagus pushes up through the diaphragm. As a result, a small part of the stomach and the LES come to lie in the chest, and the LES is no longer at the level of the diaphragm.
what-are-symptoms-of-uncomplicated Acid Reflux Disease

What is GERD (acid reflux)?












What is GERD (acid reflux)?


Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the esophagus. The liquid can inflame and damage the lining (cause, cause esophagitis) of the esophagus although visible signs of inflammation occur in a minority of patients. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed-up into the stomach from the duodenum. (The duodenum is the first part of the small intestine that attaches to the stomach.) Acid is believed to be the most injurious component of the refluxed liquid. Pepsin and bile also may injure the esophagus, but their role in the production of esophageal inflammation and damage is not as clear as the role of acid.


Gastroesophageal reflux disease is a chronic condition. Once it begins, it usually is life-long. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition. Moreover, after the esophagus has healed with treatment and treatment is stopped, the injury will return in most patients within a few months. Once treatment for
Gastroesophageal reflux disease is begun, therefore, it usually will need to be continued indefinitely although it is argued that in some patients with intermittent symptoms and no esophagitis, treatment can be intermittent and done only during symptomatic periods.

In fact, the reflux of the stomach's liquid contents into the esophagus occurs in most normal individuals. One study found that reflux occurs as frequently in normal individuals as in patients with GERD. In patients with
Gastroesophageal reflux disease, however, the refluxed liquid contains acid more often, and the acid remains in the esophagus longer. It has also been found that liquid refluxes to a higher level in the esophagus in patients with GERD than normal individuals.

As is often the case, the body has ways (mechanisms) to protect itself from the harmful effects of reflux and acid. For example, most reflux occurs during the day when individuals are upright. In the upright position, the refluxed liquid is more likely to flow back down into the stomach due to the effect of gravity. In addition, while individuals are awake, they repeatedly swallow, whether or not there is reflux. Each swallow carries any refluxed liquid back into the stomach. Finally, the salivary glands in the mouth produce saliva, which contains bicarbonate. With each swallow, bicarbonate-containing saliva travels down the esophagus. The bicarbonate neutralizes the small amount of acid that remains in the esophagus after gravity and swallowing have removed most of the liquid.
Acid Reflux Disease..
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Gravity, swallowing, and saliva are important protective mechanisms for the esophagus, but they are effective only when individuals are in the upright position. At night during sleep, gravity is not in effect, swallowing stops, and the secretion of saliva is reduced. Therefore, reflux that occurs at night is more likely to result in acid remaining in the esophagus longer and causing greater damage to the esophagus.

Certain conditions make a person susceptible to Gastroesophageal reflux disease. For example, GERD can be a serious problem during pregnancy. The elevated hormone levels of pregnancy probably cause reflux by lowering the pressure in the lower esophageal sphincter (see below). At the same time, the growing fetus increases the pressure in the abdomen. Both of these effects would be expected to increase reflux. Also, patients with diseases that weaken the esophageal muscles (see below), such as scleroderma or mixed connective tissue diseases, are more prone to develop Gastroesophageal reflux disease.

Gastroesophageal reflux disease

Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of stomach acid to the esophagus. A typical symptom is heartburn.

This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia.

A different type of acid reflux which produces respiratory and laryngeal manifestations is laryngopharyngeal reflux (LPR), also called extraesophageal reflux disease (EERD). Unlike GERD, LPR is unlikely to produce heartburn, and is thus sometimes called silent reflux.