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Gastroesophageal Reflux Disease

more about Gastroesophageal Reflux Disease

Indigestion, heart burn, or reflux

  • Food is brought through the chest from the mouth to the stomach by a tube called the esophagus. Between the end of the esophagus and stomach there is a muscular valve called a sphincter. This valve prevents stomach contents (food, acid, etc.) from going back into the esophagus. When acid from the stomach gets into the esophagus and causes symptoms or medical problems, it is known as gastroesophageal Reflux disease.
  • Reflux symptoms occur because: 1) the esophageal sphincter is not working properly and acid Refluxes ("backs up") into the esophagus; 2) acid that gets Refluxed into the esophagus is not neutralized; or 3) stomach contents are not emptying properly and things "back upward" to the esophagus.

  • Heart Burn usually 30-60 minutes after eating
  • Heart Burn after lying down or sleeping
  • Relief of symptoms from antacids
  • Chronic dry cough or wheezing
  • Chest pain (not associated with exercise)

  • Endoscopy -- scope passed from mouth into esophagus. It shows irritation of the esophagus.
  • Barium swallow -- sometimes helpful
  • pH monitoring of esophagus -- rarely, if diagnosis is unclear
  • Esophageal manometry -- measures esophageal pressures. Also done only if diagnosis is unclear.

  • Life-style modifications:
    1. Avoid alcoholic beverages
    2. Avoid caffeinated beverages and chocolate
    3. Avoid specific foods that produce your symptoms (individually determined)
    4. Weight loss -- often helps overweight individuals
    5. Do not lie down within 3 hours of eating.
    6. Sleep with block or wedge under mattress slanted down (head raised to keep acid from flowing up)
  • Medications:
    1. Antacids (Maalox) helps in milder cases (may need every four hours)
    2. H2 receptor blockers, e.g., Zantac, Tagamet
    3. Proton pump inhibitors (Prilosec) -- the strongest medicine for suppressing acid
    4. Reglan (metochlopramide) -- makes food move forward down gastrointestinal tract. Benefits some, especially diabetics.
  • Surgery if all medications fail, strictures recur, or severe inflammation of esophagus is present. Surgery is called a Nissen fundoplication. With the advent of the proton pump and inhibitor medications, surgery is now rarely needed.

  • Barrett's Esophagus -- a condition in which the cells of the lower esophagus become abnormal. It is caused by years of chronic acid irritation from acid Reflux. This condition may turn into cancer, and therefore must be monitored closely. Reflux disease is treated aggressively.
  • Peptic stricture -- an area of the esophagus becomes narrowed and scarred. It is treated with balloon dilation.

more about Gastroesophageal Reflux Disease

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