GASTROESOPHAGIAL REFLUX DISEASE (GERD)
DESCRIPTION
Gastroesophageal reflux disease (GERD) is a chronic digestive system disease, in which stomach acid, occasionally bile acid, backs up into the esophagus. It is a disease with This backflow causes irritation in your esophagus, causing the signs and symptoms of GERD.
At the beginning of the signs and symptoms are mouth watering and heartburn. These two symptoms are quite common among digestive system complaints. If these symptoms are seen at least twice a week or if these complaints are seen so much that they affect your daily life, you should consult a doctor.
In most patients, lifestyle changes and certain medications can reduce heartburn and reflux complaints. However, most harvests do not respond either to lifestyle changes or to the medications they are taking. Many patients need strong drug treatments or even surgery to reduce or completely eliminate these complaints.
WHAT ARE THE SYMPTOMS?
A burning sensation in the chest that can sometimes spread to the throat, leaving a bitter taste in the mouth.
Chest pain
Painful swallowing
Dry cough
Hoarseness or sore throat
Bitter water in mouth
Sensation of a lump in the throat
WHEN TO SEE THE DOCTOR?
GERD, heartburn and stomach pain are the diseases most often confused with heart diseases, especially heart attack. For this reason, if you have a sudden onset of chest burning, shortness of breath, and pain that spreads to the chin and left arm, it would be beneficial to see a doctor urgently to avoid a heart attack.
If it is determined that these complaints are not from the heart and you have been experiencing these symptoms frequently for a long time, it would be beneficial to see a doctor in terms of GERD. Likewise, if you need to take medication more than 2 times a week for your heartburn, it is useful to consult your doctor.
WHAT ARE THE CAUSES?
GERD is caused by frequent reflux of stomach or bile into the esophagus. During swallowing, the circular muscles at the lower end of the esophagus relax and open to allow the swallowed food to pass into the stomach, and they close again by contraction after the food passes into the stomach. However, if this relaxation and contraction is abnormal or if the muscles there are weakened, stomach acid and its contents may escape back into the esophagus. This is manifested by burning in the stomach and chest. Backing up stomach acid can cause irritation in the esophagus, causing inflammation (esophagitis) over time. Over time, as this event continues, this inflammation causes sores in the esophagus, which can cause problems ranging from bleeding and respiratory problems.
WHAT ARE THE RISK FACTORS?
Some causes increase the risk of GERD;
Obesity
Hiatus hernia (stomach hernia)
Pregnancy
Smoking
Asthma
Diabetes
Delayed gastric emptying
Connective tissue diseases such as scleroderma
Zollinger -Ellison syndrome
WHAT RESULTS CAN GERD WITHOUT TREATMENT?
Narrowing in the esophagus (esophageal stricture): frequent passage of stomach acid to the underside of the esophagus causes scar tissue to form by damaging the cells in the lower part of the esophagus. This causes narrowing of the esophagus over time.
Wound in the esophagus (esophageal ulcer): As a result of frequent encounters of the esophagus with stomach acid, wounds may occur in the esophagus. These sores can cause bleeding, pain, and difficulty swallowing.
Precancerous changes (barret esophagus): Barret esophagus occurs as a result of changes in the color and structure of the lower esophagus tissue. Structural changes in cellular size here are associated with an increased risk of esophageal cancer. Although the risk of cancer in Barrett’s esophagus is low, your doctor may order regular endoscopy checks.
HOW IS THE DIAGNOSIS DIAGNOSED?
Upper esophageal radiography with barium: Although this examination, also known as medicated film, can provide information for reflux, stomach and duodenal ulcers, it is often insufficient. It is now used very rarely in the diagnosis of reflux.
Upper esophagus – stomach endoscopy: Endoscopy is the most successful imaging method in showing the esophagus and stomach. It is a very useful method for imaging changes in the esophagus and stomach, as well as ulcers, and taking biopsy when necessary. Endoscopy is also important in showing complications such as barret esophagus formation. It can be done for diagnosis and treatment purposes.
Monitoring the amount of lower esophageal acid (PH monitarization): It is a method that shows how much the lower esophagus is exposed to stomach acid through a thin tube that is advanced from the nose to the lower end of the esophagus. This pipe is connected to a small computer that measures acid. This computer measures how long and how much acid your esophagus has been exposed to.
Measuring the movement of the esophagus: This test, called the esophageal motility test, is used to measure the mobility of the esophagus and the pressure of the circular muscles surrounding the lower esophagus. This test is also done by means of a catheter (tube) placed from the nose into your esophagus.
TREATMENT AND MEDICINES
Anti-acids that neutralize stomach acid: Although drugs such as Renie and talcid relieve the symptoms of heartburn and reflux, they are insufficient to heal the inflammation in the stomach and esophagus. Its effects are short-lived and temporary. They may show side effects such as constipation and diarrhea.
Drugs that reduce gastric acid secretion: These drugs, known as H2-receptor blockers (famodin), do not act in a short time, but they provide long-term protection. They may be insufficient when used alone.
Medicines that block stomach acid and heal the esophagus: These drugs, also known as proton pump inhibitors (lansor), block gastric acid secretion for 24 hours, giving time for the esophagus to heal.
Drugs that increase the contraction of the lower esophagus muscles and accelerate gastric emptying: These drugs, called prokinetics, accelerate gastric emptying and increase the contraction of the muscles under the esophagus. However, these drugs can have side effects such as weakness, fatigue, depression and other neurological problems.
Drugs that act by covering the stomach and esophagus mucosa (inner surface): These drugs, known as arginic acid (gaviscon), provide protection from acid by coating the inner surface of the stomach and esophagus.
Reflux disease is often used in combination with these drugs.
Surgical treatments are recommended for patients whose complaints persist despite the use of these drugs and lifestyle changes.
LIFESTYLE CHANGES
Lifestyle changes are the things that must be done in addition to medical treatment. These changes provide a reduction in stomach and reflux complaints.
Losing excess weight: Losing excess weight reduces intra-abdominal pressure, reducing the escaping of stomach acid from under the esophagus to the top.
Avoid wearing tight clothing: Tight clothing increases intra-abdominal pressure, making it easier for stomach acid to escape into the esophagus. Patients should wear comfortable and wide clothing.
Avoid foods and drinks that increase your heartburn: The effects of food and drink on people vary. In some patients, foods and drinks that do not cause complaints may occur in others. For this reason, the patient should stay away from foods and beverages that cause complaints. Foods that can cause heartburn and reflux commonly include: Avoiding foods such as fatty foods, fast food, tomato sauce, alcohol, chocolate, mint, garlic, onion, coffee can reduce reflux and heartburn.
Eat little often
Do not lie down or lie down for at least 2 hours after a meal
Raise the head of your bed
Quit smoking
Dr. . Cem Özcan
Internal Medicine Specialist
