Gastro-esophageal reflux disease
Gastroesophageal Reflux Disease (or GERD) is the rising (reflux) of gastric contents from the stomach into the esophagus.
Having GERD indicates incompetence of the lower esophageal sphincter. Long term GERD leads to esophagitis. This in turn may lead to the development of Barrett's esophagus, esophageal strictures, esophageal ulcers and possibly even to esophageal cancer.
Symptoms
The most prominent symptom of GERD is heartburn, the sensation of burning pain in the chest coming upward towards the mouth caused by reflux of acidic contents from the stomach to the esophagus.
Patients with GERD also tend to get waterbrash, the feeling of a sour taste at the back of their throats. This can sometimes happen even if the pain of heartburn is absent.
Diagnosis
A detailed history taking is vital to the diagnosis. Useful investigations may include barium swallow X-rays, esophageal manometry, esophageal pH monitoring and gastroscopy.
Treatment
Avoiding aggravating factors
Certain foods and lifestyle tend to promote gastroesophageal reflux. Coffee and alcohol are stimulants of gastric acid secretion so avoiding these helps. Foods high in fats and smoking reduce lower esophageal sphincter competence so avoiding these tends to help as well. Having more but smaller meals also reduces the risk of GERD as it means there is less in the stomach at any one time.
Drug treatment
Antacids before meals or symptomatically after symptoms begin can reduce gastric acidity. Gastric H2 receptor blockers such as ranitidine can reduce gastric secretion of acid. Proton pump inhibitors such as omeprazole are even more effective in reducing gastric acid secretion.
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