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GERD: Introduction
“Gastroesophageal reflux disease (GERD) is a syndrome wherein the stomach’s contents of those in the small intestine constantly move up into the esophagus. The rearwards motion of the contents is called a “reflux.” This condition results in the person being subjected to episodes of heartburn, a stinging sensation felt under the sternum part of the chest, is the initial symptom of heartburn; this is traditionally felt after the person has a heavy meal, or lies down or lifts a heavy object immediately after eating. If a person is consistently experiencing bouts of reflux and extreme heartburn, then the person may have GERD, which is one of the most common gastrointestinal illnesses (University of Maryland Medical Center, 2016).
Epidemiologic statistics of the pervasiveness of GERD has been anchored on the common symptoms of the condition, which are heartburn and vomiting. An extensive review evinced that the prevalence of GERD is at 10-20 percent in the Western countries and lower in the Asian region. In the study, vomiting was disclosed in 16 percent of the cases; however, differentiating cardiac-related from non-cardiac related chest pains must be studied to separate the two as a symptom of GERD. Research studies show that as the person ages, the frequency for the occurrence of the symptoms of the condition is not raised; withal, the severity of the symptoms of the condition intensifies when the person reaches the age of 50 years old (Katz, Gerson, Vela, 2013).
“Gastroesophageal” refers to the area of the esophagus and stomach. In the operation of normal digestive processes, the “lower esophageal sphincter (LES) opens to allow the passage of food into the stomach and then closes to avoid the food from moving back into the esophagus. When the LES is weak is relaxed, the contents of the stomach will be released back into the esophagus (WebMD, 2016). One of the more cited causes of reflux is “hiatal hernia,” which is a hole in the diaphragm where the stomach is joined to the esophagus. The breach will allow the uppermost part of the stomach to protrude through the diaphragm and leak into the chest area, disturbing the normal operation of the LES (Nemours Foundation, 2016).
Hiatal hernia can be contracted by coughing, regurgitating, excessive straining, and abrupt physical exertion. Withal, this condition generally can be addressed without much treatment; nonetheless, the condition may require medical attention if the breach is threatening to cut off the person’s blood flow or is with another condition such as esophagitis. Food choices also raise the risk of the person experiencing GERD; certain foodstuffs and beverages, such as chocolate, peppermint, fried and fatty food items, coffee, and alcohol can induce heartburn and reflux; additionally, people who are smokers can contribute to the LES weakening thus facilitating acid reflux (WebMD LLC, 2016).
Scope of disease and Risk factors
It is estimated that 50 percent of all American adults experience GERD at least once a month. The condition is not “age-specific;” all age groups are exposed to the possibility of experiencing GERD. However, it has been seen that the elderly have a higher risk factor of experiencing GERD or experiencing a more acerbic GERD experience compared to the younger demographics in society. As mentioned earlier, there are a number of risk factors that heighten the possibility of the person having GERD. Aside from eating too much and the immediately lies down or bends down from the waist, pregnancy is also a risk factor. This is particularly true when the expectant mother is in her third trimester when the expanding uterus of the mothers squeezes the woman. In these situations, antacids and even dietary changes are inadequate to address and counter heartburn.
Being inordinately overweight is also a risk factor GERD. There are a number of research studies that proffer that fatness are among the factors in the contraction of GERD; in addition, paunchiness amplifies the risk that the person will incur “erosive esophagitis” among individuals with GERD. Accumulating an inordinate amount of fat in the abdominal area can prove to the most critical risk elements for developing acid reflux and other related complications inclusive of Barrett’s esophagus and cancer of the esophagus. Moreover, analysts have found that having a higher “body mass index (BMI) is associated with having a higher risk to incur the more severe forms of GERD. In this light, decreasing or reducing the weight of the person can help in avoiding GERD syndromes. Withal, “gastric banding surgery” can negatively impact people who have GERD or may contribute to the contraction of GERD.
Cigarette and consumption of tobacco products also contributes to people having acid reflux. There is a growing body of evidence that smoking helps in contracting GERD; smoking disables the proper functioning of the LES, raises the amount of acid that is released, and harms protective mucus coverings. In addition, smoking decreases saliva production that aids in the neutralization of acid in the body. Nonetheless, there is no proof whether nicotine, smoke, either singularly or in combination, trigger GERD in an individual. There are evidences that people who use “nicotine patches” rather than consuming cigarettes or other tobacco products are exposed to risks for heartburn; however, it us vague whether the nicotine or does stress generates the reflux (Remedy Health Media LLC, 2015). Certain food items also contribute to the development of GERD. Among these food items include chocolate, caffeinated drinks, garlic and onions, spicy dishes, spaghetti, chili, pizza, or any dish using tomatoes or tomato based products (Nemours, 2016).
In addition, aside from GERD, smoking also contributes to emphysema, which is a form of COPD, which is another risk factor for GERD (Remedy Health Media LLC, 2015). Lastly, people with respiratory conditions such as asthma face a higher risk for contracting GERD. When the condition flares up, this can lead to the LES to loosen, which allows the contents in the stomach to move rearwards back into the esophagus. What is worse is that certain medications for treating asthma flare ups such as theophylline can exacerbate reflux effects. Also, GERD can worsen the symptoms of asthma by inflaming the lungs and the air passages of the person. These in turn will result in a more severe asthma flare up. The irritation can degenerate and worsen “allergic reactions” and render the airways overly sensitive to environmental elements such as freezing temperatures or smoke (American Academy of Allergy Asthma and Immunology, 2016).
Possible outcomes
If let unaddressed, the persistent inflammation in the esophagus can result in a number of dangerous health conditions; one, the lower esophagus will narrow resulting from the incurred damage to the cells from being exposed to high levels of acid that in turn will lead to the development of scar tissue; the accumulated tissue will constrict the food ducts making it difficult for the person to swallow. Two, the person will develop a festering sore in the esophagus; this condition is developed as stomach acids will inflict serious esophagus tissue erosion. The ulcer will bleed, making it extremely painful for the person to swallow.
Lastly, the person with a GERD syndrome can incur Barrett’s esophagus; the tissue that borders the esophagus changes that amplifies the risk for esophageal cancer (Mayo Clinic, 2016). If a person has Barrett’s esophagus, the risk for contracting esophagus cancer is heightened; this is particularly if the individual has a family history of the condition. Indicators for this type of cancer includes difficulty in swallowing and pain in the chest area do not appear in the patient until such time that the illness has degenerated (WebMD, 2016).
Testing, Diagnosis and Treatments
Practitioners can opt to test an individual for the condition to determine if the person has GERD or to jettison other possible conditions. One is the use of a “barium swallow radiograph,” a specialized X-ray procedure that can aid doctors in determining whether fluid is flowing back into the person’s esophagus. In addition, this procedure can evince the possibility if the esophagus is inflamed or whether there are other conditions in the esophagus or the stomach that contributes to the possibility whether the person will have GERD. In the test, the person ingests barium infused solution and the X-ray machine will then be used to trace the direction of the solution in the person.
Another procedure is the use of a “gastric emptying scan;” this process will show if the stomach of the person empties too slow, which can generate a higher risk for the person to incur a reflux. The test is done with the individual asked to drink a glass of milk with a tracer mechanism mixed into the milk or by consuming scrambled eggs that also has a tracer in it. A non-radiological mechanism will then be used to track the movement of the tracer as well as the rate that the stomach is being emptied.
Lastly, the “upper endoscopy” test permits the doctor to examine the esophagus, a portion of the small intestines, and the stomach with the use of a small camera. In this examination, the doctor can choose to give the patient medication designed to relax the patient, or squirt the tongue to numb it. This will make the conduct of the test more comfortable for the patient. Majority of the patients that undergo this procedure are sedated or given anesthesia to put them to sleep. After the patient is sedated, the doctor will then insert an “endoscope,” a thin plastic tube with a camera at the end; the camera helps the doctor to identify, if any, anomalies on the esophagus’ surface and the lining of the stomach. During the course of the procedure, the doctor can use forceps to extract a small amount of tissue for a biopsy; this can reveal any damage that was caused by the acid flow back or infections or facilitate in ruling out any other physical condition (Nemours, 2016).
Many cases of heartburn are considered treatable; nonetheless, increased instances of heartburn or GERD can warrant the consideration of surgical intervention. This is particularly needed when changes in the lifestyle or the treatment regimens fail in addressing the conditions of the patient. Surgery can also be considered if GERD is contributing to the development of other conditions. Heartburn that will not subside even with the exhaustion of all non-invasive procedures is the most cited justification for surgical treatment.
Aside from this factor, pother reasons surgery can be considered for treatment of heartburn or GERD symptoms include “esophagitis,” if the esophagus is constricting but is not due to cancer, and Barrett’s esophagus. Nonetheless, when surgery is being considered, there must be an acknowledgement that this option carries a high risk level; in this light, this must only be considered as a last option when all possible non-surgical options have been exhausted and there is evidence that surgical intervention has a good chance of succeeding (WebMD, 2016).
References
American Academy of Allergy Asthma and Immunology (2016) “Gastroesophageal reflux disease (GERD)” Retrieved 6 June 2016 from <http://www.aaaai.org/conditions-and-treatments/related-conditions/gastroesophageal-reflux-disease
Katz, P.O., Gerson, L.B., and Vela, M.F (2013) “Diagnosis and management of gastroesophageal reflux disease” Retrieved 6 June 2016 from <http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/
Mayo Clinic (2016) “GERD” Retrieved 6 June 2016 from <http://www.mayoclinic.org/diseases-conditions/gerd/basics/definition/con-20025201
Nemours Foundation (2016) “Gastroesophageal reflux disease (GERD)” Retrieved 6 June 2016 from <http://kidshealth.org/en/teens/gerd.html#
Remedy Central Health Media LLC (2015) “Acid reflux (GERD) and the esophagus” Retrieved 6 June 2016 from <http://www.healthcentral.com/acid-reflux/encyclopedia/acid-reflux--and-the-esophagus-4000689/introduction/
WebMD (2016) “Gastroesophageal reflux disease” Retrieved 6 June 2016 from <http://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1?page=3
