Gastro esophageal reflux disease is a digestive disorder that has effects on the lower esophageal sphincter, which is the ring that is found between the stomach and esophagus (Mayo Clinic, 2016). The contents of the stomach get backed up in the esophagus. This condition is experienced especially when the lower esophagus sphincter becomes weak hence allowing the contents of the stomach to flow back into the esophagus (Doig & Huether, 2014). This disorder is known to cause heartburn to pregnant women. GERD has proved to be the most common outpatient gastroenterological diagnosis witnessed in the United States. The prevalence rate is at 10-30% as well as annual incidence in the western world being 0.38-0.45%. 20% of adult population in the United States experiences this condition on a weekly basis (Doig & Huether, 2014). GERD reduces the quality of life and also an economic burden to the families of the affected persons. However, this disease can be controlled through lifestyles changes and diet, although there are persons who prefer medication or surgery (Doig & Huether, 2014). The risk factors for this disease include a hiatal hernia, obesity, and chemicals and drugs that end up relaxing the lower esophagus sphincter.
The resting tone of the lower esophagus sphincter becomes lower and weaker (Doig & Huether, 2014). Vomiting, lifting, coughing, bending and obesity increase the level of abdominal pressure resulting to reflux of the esophagus (Mayo Clinic, 2016). When there is delayed emptying of the gastric, acidic content in the chime increases and the period in which reflux is possible becomes long. This disease causes inflammatory responses that end up causing edema, hyperemia, tissue fragility, ulcer actions, and erosion. People with this disease experience heartburns after having a heavy meal.
A hiatal hernia is commonly experienced in patients that are suffering from GERD. The stomach of the affected person is dislocated through the diaphragm hiatus into the chest and the crural diaphragm gets separated from the lower esophagus sphincter (Doig & Huether, 2014). The integrity of the gastro-esophageal sphincter is disrupted increasing the level of exposure of esophageal acid. This, therefore, shows that a hernia plays a very big role in sustaining GERD because of its effects of lowering the functioning of the lower esophagus sphincter. Additionally, hernia acts as acid reservoir since a lot of acids become trapped during the clearance of esophagus acid.
GERD is also caused by visceral hypersensitivity. Patients with GERD symptoms have been seen to experience hypersensitivity to pain especially in the absence of excessive exposure to esophageal acid (Doig & Huether, 2014). Normal esophageal acid makes patients experience symptoms of GERD due to visceral hypersensitivity. This happens since there is an alteration of the cerebral processing of the sensory input via cortical neural activity.
Consequently, the impairment of the ability of the mucosa to resist any injury causes GERD. This is because esophageal mucosa has several functional and structural components that protect and defend it from any noxious luminal things (Mayo Clinic, 2016). When the esophageal defense is overwhelmed by aggressive factors, injury of the mucosal occurs. The acid pepsin and acid attacks and damage intercellular junctions increasing the permeability of the Paracellular. This helps to explain why patients with GERD experience heartburns as well as symptoms of reflux disease.
Additionally, GERD is the main cause of a variety of conditions that affects extra-esophageal structures. Some of these conditions include the pulmonary diseases and symptoms like asthma, pulmonary fibrosis and bronchitis (Doig & Huether, 2014). Otolaryngologist findings, like laryngitis, cough, hoarseness, laryngeal cancer, and subglottis stenosis. Lastly, other conditions may include; sinusitis, dental erosions, and pharyngitis. The pharynx and larynx are very close to the esophagus and this increase the chances of these organs being exposed to gastric refluxate (Doig & Huether, 2014). The laryngeal mucosa is more sensitive than the esophageal mucosa to the exposure of this gastric reflux the reason being of its lower expression of carbonic anhydrase. Carbonic anhydrase contains an enzyme that provides protection to the mucosa against exposure of acids.
Diagnosis of patients who have GERD starts with a mandatory upper gastrointestinal endoscopy, esophageal manometry and 24 hours monitoring of the PH levels (Hershcovia & Fass, 2011). Upper gastrointestinal is the initial procedure in the workup gastro esophageal reflux disease (Hershcovia & Fass, 2011). Plain chest radiographic findings can as well be used to evaluate and monitor this condition in the body. They help to assess the pulmonary status and also the basic anatomy. Having chest images will demonstrate large hiatal hernia but this will not help in seeing small hernias. It is important to note that the diagnosis of GERD depends on whether the symptoms are uncomplicated or complicated (Doig & Huether, 2014). The uncomplicated symptoms such as heartburns and regurgitation can be relieved by using antacids. A single dose of PPI can as well be used to treat them.
Treatment of GERD requires a stepwise approach. Medication can be used to treat the condition (Mayo Clinic, 2016). Over the counter antacids are one of the many medication treatments that can be used to treat the condition. They offer a short term relief from pain caused by GERD. They are mostly used to treat break-through symptoms that can not be treated using PPI medication (Hershcovia & Fass, 2011). Antacids cannot provide healing to erosive esophagitis.
Histamine H2 receptor Antagonist medication just like antacids is used to provide relief of pain from the condition temporarily but the action of this treatment is much slower than that of antacids (Hershcovia & Fass, 2011). However, the use of this medication for a long period of time to treat GERD is not recommended since it develops tolerance with the first weeks of use and also they are not effective like PPIs.
A prokinetics medication helps in the suppression of acid in the gut but the relief of the symptom when using this method is slow in the onset. These medications cannot be used to treat sophisticated symptoms (Doig & Huether, 2014). However, this method of treatment has its side effects since it causes tremor, fatigue, tardive dyskinesia, and there is increased the risk for cardiac events.
Proton pump Inhibitors (PPIs) is the standard method for the treatment of GERD. PPIs function by blocking the gastric acid pump in the stomach (Hershcovia & Fass, 2011). This pump is commonly referred hydrogen ATPase. PPIs provide long-term treatment of esophageal erosion. This medication functions by blocking the pumps in the stomach that make acids. But for this treatment to function well, it must be taken on an empty stomach that is before any meal to the pumps before they are stimulated by food (Doig & Huether, 2014). There are some concerns with the use of PPIs in the treatment of GERD like failure to respond, atrophic gastritis and rebound gastritis.
Beside medication, surgery can also be used to treat GERD. This procedure is undertaken to wrap the fundus of the stomach around the esophagus in order to create a new cardiac valve equivalent (Patrick, 2011). Surgery is recommended for patients diagnosed with erosive GERD, patients having poor compliance with medication, Barrett’s esophagus, and serious respiratory manifestation of GERD. But patients who undergo surgery still require medication. Both surgery and PPIs have appeared to be an effective way of improving symptoms of esophageal acid exposure.
There are alternative treatments for GERD. Reducing weight is one of the alternative ways to reduce GERD. There is a need to maintain a healthy weight. GERD symptoms are increased with the increase in the body mass index with measures ratio of weight in relation to the height (Patrick, 2011). Weight loss is the most effective long-term solution to GERD. This is because it will help to reduce the heartburns symptoms. Overweight has a habit of increasing pressure in the abdomen causing influx. Fat cells secrete estrogen that makes the muscles in the esophagus sphincter to relax. Women who increase weight experience heartburns the more than those who maintain a healthy weight.
There is also need for people suffering from this condition to avoid using alcohol, chocolate, citrus juice, and tomato-based products (Patrick, 2011). It is recommended to eat small and frequent meals rather than large meals and patients should wait for three hours before lying down. Observing this mechanism helps in reducing the impacts of GERD to the patients since they help to reduce heartburns.
Conclusively, GERD is a condition that develops especially when the reflux of contents of the stomach causes complications. This condition weakens the lower esophagus sphincter allowing stomach contents to flow back into the esophagus (Hershcovia & Fass, 2011). This condition affects the health of the affected person as well as increasing economic burden. The risk factors associated with the condition are an obesity and hiatal hernia. The symptoms of this condition are the heartburn, regurgitation, and dysphasia. The condition can be treated and managed using non-pharmacotherapy, pharmacotherapy and surgical methods.
References
Doig, A. K., & Huether, S. E. (2014). Alterations of digestive function. In K. L. McCance & S. E. Huether (Eds.), Pathophysiology: The biologic basis for disease in adults and children (7th ed.) (pp. 1423-1485). Missouri: Elsevier.
Hershcovia, T., & Fass, R. (2011). Gastro-Oesophageal reflux diesase: Beyond proton pump inhibitor therapy drugs, 71(18), 2381-2389 9p. doi:10.2165/11597300-000000000-00000
Mayo Clinic. (2016). GERD - Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/gerd/basics/definition/con-20025201
Patrick, L. (2011). Gastro esophageal reflux disease (GERD): A review of conventional and alternative treatments alternative medicine review, 16(2), 116-133 18p.
