Gastro esophageal reflux disease (GERD)

Gastroesophageal reflux is a normal process , which consists of physiological retrograde movement without effort, the gastric contents to the esophagus . Gastroesophageal reflux occurs several times a day , especially after large meals , without causing symptoms or esophageal mucosal injury .Gastroesophageal reflux disease (GERD ) occurs when the amount of gastric contents into the esophagus is refluxed than normal , causing symptoms , with or without esophageal lesions (eg, esophagitis ) . This is the consequence of exceeding normal antireflux mechanisms .Esophageal lesions arising from the imbalance between factors of esophageal lining Defense ( antireflux barrier clearance luminal esophageal tissue resistance ) and aggression factors contained in fluid reflux ( hydrochloric acid and pepsin , bile salts , pancreatic enzymes ) .Gastroesophageal reflux disease (GERD ) can occur at any age and is more common in adults over 40 years. Both sexes are affected equally , but men having a higher incidence of complications . Gastroesophageal reflux disease is seen in 25-75 % of pregnant women, debuting symptoms usually disappear during pregnancy and soon after birth.The main symptoms (classes) of GERD are:
    heartburn : Heartburn feeling inferior , which may radiate to the neck upward , occurs especially after large meals or after consumption of fat, spice , citrus, alcohol, coffee , chocolate , mint, and so on , but in certain positions ( anteroflexie , lying)
    regurgitation : refluxed gastric contents into the mouth, vomiting effortlessOther symptoms of GERD are:

      
Dysphagia : difficulty in swallowing food bolus
    swallowing : pain swallowing food bolus ( painful swallowing )
    extraesofagiene events : noncardiac chest pain , pulmonary symptoms ( cough , asthma , aspiration pneumonia ) , larynx ( hoarseness , dysphonia ) , throat ( pharyngitis ) , halitosis , chronic hiccups , globus sensation ( " lump in the throat " ) , dental erosionIn most cases this classic symptoms ( heartburn and regurgitation ) is sufficient to establish the diagnosis of gastroesophageal reflux disease and start the treatment. In general, diagnostic tests are reserved for cases that do not respond to medical treatment or patients with warning signs (dysphagia , odynophagia , weight loss , anemia, gastrointestinal bleeding ) or extraesofagiene events . Also, older age and family history of cancer of the upper digestive tract requires patient investigation .Investigations are useful :

    upper endoscopy with biopsy sampling : the ideal method for esophageal mucosal lesion induced reflux , assessing their extension and exclusion of other causes , only 40-60 % of patients with GERD endoscopic changes of the distal esophagus shows
    Esophageal pH meter : Ambulatory monitoring of esophageal pH for 24 hours
    other methods: barium X-ray examination , esophageal manometry , etc. .Gastroesophageal reflux disease may be complicated by :

    reflux esophagitis ( esophagitis peptic ) - the most common
    esophageal ulcers , which can cause gastrointestinal bleeding or perforation rarely esophageal
    Peptic esophageal stenosis
    Barrett's esophagus ( premalignant lesions at risk of developing esophageal adenocarcinoma )Treatment of gastroesophageal reflux disease is mainly medical ( lifestyle modification and drug therapy ) or endoscopic antireflux surgery being required only a small proportion of patients.Lifestyle changes consist of the following steps :

    stopping smoking
    avoiding excessive alcohol consumption
    raising headboards 5-10 cm
    avoid supine for 3 hours after a meal
    Weight loss - for overweight patients
    avoid heavy meals (preferably 3 meals a day with 2 snacks interspersed )
    Avoiding fats , coffee, chocolate , tea, soft drinks , mint , citrus , tomatoes , spices , onion , garlic , vinegar
    immediately after a meal to avoid leaning
    avoid drugs: aspirin, theophylline , diazepam , estrogen , progesterone , etc. .Drug treatment is based on the use of the following classes of drugs :
    antacids : neutralizes stomach acid refluxed with rapid relief of symptoms
    antisecretory : inhibits gastric acid secretion - H2 receptor blockers and proton pump inhibitors
    prokinetic : stimulates gastric emptying and esophageal clearance
    protective mucosalOr endoscopic antireflux surgery is indicated for failure of drug treatment in controlling symptoms and healing esophagitis in patients requiring long-term antireflux therapy for the prevention of clinical relapse .