Most Researched disease of this century (except HIV aids) is Gastroesophageal reflux disease (GERD).This GERD is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.
Causes, incidence, and risk factors of GERD:-
When you eat, food passes from the throat to the stomach through the esophagus (also called the food pipe or swallowing tube). Once food is in the stomach, a ring of muscle fibers prevents food from moving backward into the esophagus. These muscle fibers are called the lower esophageal sphincter, or LES.
If this sphincter muscle doesn't close well, food, liquid, and stomach acid can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms, or it can even damage the esophagus.
The risk factors for reflux include:
Alcohol (possibly)
Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)
Obesity
Pregnancy
Scleroderma
Smoking
Heartburn and gastroesophageal reflux can be brought on or made worse by pregnancy and many different medications. Such drugs include:
Anticholinergics (e.g., for seasickness)
Beta-blockers for high blood pressure or heart disease
Bronchodilators for asthma
Calcium channel blockers for high blood pressure
Dopamine-active drugs for Parkinson's disease
Progestin for abnormal menstrual bleeding or birth control
Sedatives for insomnia or anxiety
Tricyclic antidepressants
If you suspect that one of your medications may be causing heartburn, talk to your doctor. Never change or stop a medication you take regularly without talking to your doctor.
More common symptoms of GERD are:-
If this sphincter muscle doesn't close well, food, liquid, and stomach acid can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms, or it can even damage the esophagus.
The risk factors for reflux include:
Alcohol (possibly)
Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)
Obesity
Pregnancy
Scleroderma
Smoking
Heartburn and gastroesophageal reflux can be brought on or made worse by pregnancy and many different medications. Such drugs include:
Anticholinergics (e.g., for seasickness)
Beta-blockers for high blood pressure or heart disease
Bronchodilators for asthma
Calcium channel blockers for high blood pressure
Dopamine-active drugs for Parkinson's disease
Progestin for abnormal menstrual bleeding or birth control
Sedatives for insomnia or anxiety
Tricyclic antidepressants
If you suspect that one of your medications may be causing heartburn, talk to your doctor. Never change or stop a medication you take regularly without talking to your doctor.
More common symptoms of GERD are:-
Feeling that food is stuck behind the breastbone
Heartburn or a burning pain in the chest (under the breastbone)
Increased by bending, stooping, lying down, or eating
More likely or worse at night
Relieved by antacids
Nausea after eating
Less common symptoms are:
Bringing food back up (regurgitation)
Cough or wheezing
Difficulty swallowing
Hiccups
Hoarseness or change in voice
Sore throat
Signs and tests
You may not need any tests if your symptoms are not severe.
If your symptoms are severe or they come back after you have been treated, one or more tests may help diagnose reflux or any complications:
Esophagogastroduodenoscopy (EGD) is often used to find the cause and examine the esophagus (swallowing tube) for damage. The doctor inserts a thin tube with a camera on the end through your mouth. The tube is then passed into your esophagus, stomach, and small intestine.
Barium swallow
Continuous esophageal pH monitoring
Esophageal manometry
A positive stool occult blood test may diagnose bleeding that is coming from the irritation in the esophagus, stomach, or intestines.
Treatment of GERD:-
You can make many lifestyle changes to help treat your symptoms. Avoid foods that cause problems for you. Making changes to your routine before you go to sleep may also help.
Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain. Take your medicines with plenty of water. When your doctor gives you a new medicine, remember to ask whether it will make your heartburn worse.
You may use over-the-counter antacids after meals and at bedtime, although they do not last very long. Common side effects of antacids include diarrhea or constipation.
Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs.
Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach
H2 blockers (antagonists) lower the amount of acid released in the stomach
Anti-reflux operations (fundoplication and others) may be an option for patients whose symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms should improve after surgery, but you may still need to take drugs for your heartburn.
There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).
Expectations (prognosis)
Most people respond to lifestyle changes and medications. However, many patients need to continue taking drugs to control their symptoms.
Complications
Asthma
Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
Bronchospasm (irritation and spasm of the airways due to acid)
Chronic cough or hoarseness
Dental problems
Esophageal ulcer
Stricture (a narrowing of the esophagus due to scarring)
Calling your health care provider
Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.
Also call for any of the following symptoms:
Bleeding
Choking (coughing, shortness of breath)
Feeling filled up quickly when eating
Frequent vomiting
Hoarseness
Loss of appetite
Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
Weight loss
Prevention
Follow heartburn prevention techniques to prevent GERD.
References
1.Richter JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 43.
2.Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-797. [PubMed]
3.Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391. [PubMed]
4.Galmiche JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized controlled trial. JAMA. 2011;305:1969-1977.
Heartburn or a burning pain in the chest (under the breastbone)
Increased by bending, stooping, lying down, or eating
More likely or worse at night
Relieved by antacids
Nausea after eating
Less common symptoms are:
Bringing food back up (regurgitation)
Cough or wheezing
Difficulty swallowing
Hiccups
Hoarseness or change in voice
Sore throat
Signs and tests
You may not need any tests if your symptoms are not severe.
If your symptoms are severe or they come back after you have been treated, one or more tests may help diagnose reflux or any complications:
Esophagogastroduodenoscopy (EGD) is often used to find the cause and examine the esophagus (swallowing tube) for damage. The doctor inserts a thin tube with a camera on the end through your mouth. The tube is then passed into your esophagus, stomach, and small intestine.
Barium swallow
Continuous esophageal pH monitoring
Esophageal manometry
A positive stool occult blood test may diagnose bleeding that is coming from the irritation in the esophagus, stomach, or intestines.
Treatment of GERD:-
You can make many lifestyle changes to help treat your symptoms. Avoid foods that cause problems for you. Making changes to your routine before you go to sleep may also help.
Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain. Take your medicines with plenty of water. When your doctor gives you a new medicine, remember to ask whether it will make your heartburn worse.
You may use over-the-counter antacids after meals and at bedtime, although they do not last very long. Common side effects of antacids include diarrhea or constipation.
Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs.
Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach
H2 blockers (antagonists) lower the amount of acid released in the stomach
Anti-reflux operations (fundoplication and others) may be an option for patients whose symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms should improve after surgery, but you may still need to take drugs for your heartburn.
There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).
Expectations (prognosis)
Most people respond to lifestyle changes and medications. However, many patients need to continue taking drugs to control their symptoms.
Complications
Asthma
Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
Bronchospasm (irritation and spasm of the airways due to acid)
Chronic cough or hoarseness
Dental problems
Esophageal ulcer
Stricture (a narrowing of the esophagus due to scarring)
Calling your health care provider
Call your health care provider if symptoms worsen or do not improve with lifestyle changes or medication.
Also call for any of the following symptoms:
Bleeding
Choking (coughing, shortness of breath)
Feeling filled up quickly when eating
Frequent vomiting
Hoarseness
Loss of appetite
Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
Weight loss
Prevention
Follow heartburn prevention techniques to prevent GERD.
References
1.Richter JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 43.
2.Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-797. [PubMed]
3.Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391. [PubMed]
4.Galmiche JP, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized controlled trial. JAMA. 2011;305:1969-1977.
5.George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California.
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