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GERD
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GERD is often the result of conditions that affect the lower esophageal sphincter (LES). The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep food in the stomach.[4] GERD is in fact not a life threatening disease therefore surgery is not a rushed decision. GERD is treatable, and there are things you can do to feel better. [6] GERD is an abbreviation for gastroesophageal reflux disease, which is the name given to frequent heartburn that disrupts life and spoils enjoyment of food and activities. [7] GERD isn't always a benign disease. Untreated, chronic GERD can lead to esophageal damage.[8] GERD is common in both women and men. Regardless of the overall sex differences in the clinical picture of this disease, management principles are generally similar, and outcomes are excellent with proper therapy.[9] GERD is often considered an adult disease and is often underdiagnosed and treated in children even though it is extremely common. [10] GERD is caused by a weakened sphincter muscle – a valve in the lower esophagus that closes after food passes from the throat to the stomach. For people with GERD, this valve malfunctions and the resulting upward flow (reflux) can cause frequent heartburn – by far the most common symptom – and possibly food sticking, regurgitation, coughing or wheezing. GERD is very common in infants, though it can occur at any age. [12] GERD is caused when harsh stomach acid backs up into the esophagus or food tube. Symptoms of GERD may include frequent and persistent heartburn that occurs two or more days a week, coughing, difficulty swallowing, and a sour or acidic aftertaste in the mouth. GERD is caused by reflux of stomach acid into the esophagus. In most patients this is due to a transient relaxation of the "gate" or sphincter that keeps the lower end of the esophagus closed when a person is not swallowing food or liquids.[14] GERD is an important inflammatory cofactor in subglottic stenosis, recurrent croup, apnea, and chronic cough, and may play a causative role. GERD may persist for many years in premature children. GERD is one of the most common medical disorders, with estimates of up to 50% of adults reporting reflux symptoms. One of the main symptoms of GERD is heartburn.[16] GERD is a very serious condition, one that is incredibly common around the world. It is much more than just heartburn, although many people confuse it as this.[17] GERD is the most common condition to affect the esophagus. The disease spectrum ranges from patients with heartburn and other reflux symptoms without morphologic evidence of esophagitis (the so-called acid-sensitive esophagus) to patients with deep ulcer, stricture or Barrett's epithelium.[18] GERD is one of the most common causes of chronic cough. While persistent cough can be caused by acid reflux, in some cases, the cough could result from the reflux of non-acidic stomach contents.[19] GERD is caused by a weak oesophageal sphincter that is present at birth or that develops later in life. A hiatal hernia can also cause GERD.[20] GERD is defined as the failure of the antireflux barrier, allowing abnormal reflux of gastric contents into the esophagus (12). It is a mechanical disorder which is caused by a defective lower esophageal sphincter, a gastric emptying disorder or failed esophageal peristalsis.[21] GERD is suspected when these measures don't resolve the symptoms, or if the child has other associated symptoms, typically lack of weight gain, bleeding or respiratory problems. In those patients, diagnostic procedures or more aggressive therapies may be needed. Acid reflux occurs when this sphincter or "gate" opens at the wrong time or is too weak, allowing stomach contents to leak back (or reflux) into the esophagus. Certain foods and medications can cause promote reflux by causing relaxations or low pressure in this sphincter or "gate.".[23] Acid reflux from the stomach can trigger croup . [24] Acid reflux is a disorder that is quite common among people. However, when it takes a serious form, it becomes a disease that can lead to serious health complications in the long run.[25] Women who lost weight in the study saw a decrease in their symptoms. Research suggests that the prevalence of GERD symptoms among obese patients has been underreported.[26] Women also develop Barrett's esophagus but men outnumber women by a ratio of around 4 to 1. Up to 8 times as many men develop esophageal adenocarcinoma (Barrett's associated cancer) as women.[27] Drugs that lower LES pressure include anticholinergics, antihistamines, tricyclic antidepressants, Ca channel blockers, progesterone, and nitrates. [28] Drug therapy should be initiated with proton pump inhibitors and prokinetic agents. H2 -antagonist can be substituted for the proton pump inhibitor after 3 months.[29] Reflux is often more likely to occur after retiring at night because the esophagus loses the advantage of gravity due to its position above the acid-producing stomach. Thus, it is important to eat relatively early meals, several hours before bedtime.[31] Reflux happens when the muscle between your baby's esophagus and stomach isn't working properly, allowing food and gastric acid to gurgle up from the stomach into the throat. During your baby's first few months, vomiting is probably linked to feeding problems, such as overfeeding or indigestion; not always GERD.[32] Reflux means to back-up or flow backwards. GERD is a condition in which acid, bile and partially-digested food in the stomach back up into the esophagus.[33] Reflux that continues past 1 year of age may be GERD. [34] Heartburn symptoms may actually lessen as the esophageal opening narrows down preventing acid reflux. Stretching of the esophagus and proton pump inhibitor medication are needed to control and prevent peptic strictures.[36] Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems. [37] Heartburn, commonly referred to as acid indigestion, is a burning pain behind the breastbone, associated with a spasm or irritation of the lower end of the esophagus or upper stomach. This burning pain may also be accompanied by other symptoms such as nausea, bloating, belching, or a sour or bitter taste in the throat and mouth.[38] Heartburn is among the most common complaints seen in the Family Medicine office, in otherwise healthy people. Surveys have shown that 4-7% of persons experience daily heartburn and 15-40% monthly.[39] Heartburn is a common ailment that affects 60 million American adults at least once a month. Caused when acidic stomach juices reflux, or flow backward, into the esophagus, heartburn sufferers generally describe symptoms that include a burning mid-chest pain, a feeling that food or liquid is coming back into the mouth or throat, an acid or bitter taste at the back of the throat, or an increase in severity of pain behind the breastbone when lying down or bending over. Heartburn has nothing to do with the heart. Rather, it involves the esophagus (the tube that connects the throat to the stomach), and the stomach itself.[43] Symptoms such as diarrhea, weight loss and rectal bleeding, are similar to Crohn?s disease. Inflammation usually occurs in the rectum and lower part of the colon, but can affect the entire colon.[44] Symptom relief does not rule out other serious stomach conditions. For further information, talk with your child's healthcare provider and click here for complete Prevacid prescribing information .[45] Symptoms of GERD, however, vary from person to person and at times there may be no symptoms at all. The majority of people with GERD have mild symptoms, with no visible evidence of tissue damage and little risk of developing complications.[46] Symptoms may recur in a percentage of children. Positioning and thickened formula are used in infants as first line of therapy. Treatment consists of avoiding allergic and nonallergic triggers as well as medical treatment with antihistamines, decongestants, and/or topical prescription nasal sprays and potentially allergy desensitization. [50] Treatment with lansoprazole resulted in normalization of esophageal wall structure and improvement of motility, suggesting that lansoprazole improves not only mucosal inflammation but also submucosal inflammation in GERD. [51] Treatment for people who have symptoms of gastroesophageal reflux disease (GERD) begins with making lifestyle changes and taking antacids, or nonprescription medicines that reduce or block acid. These include H2 blockers (for example, Pepcid) or a proton pump inhibitor (for example, Prilosec OTC).[52] Patients with GERD have a weakened sphincter that allows for stomach acid to flow back into the esophagus. The esophageal lining becomes inflamed and patients experience heartburn, chest pain, and even a sour taste in their mouth.[55] Patients should eat smaller, more frequent meals and should avoid fatty foods, fibrous foods, red meat and fresh vegetables. Meals that are rich in protein and starches are preferred because they are more easily mixed and emptied by the stomach.[56] Patients may also have vomiting or chest pain. Occasionally patients have minimal symptoms but have anemia that is difficult to explain. Patients with laryngopharyngeal reflux present with symptoms related to the upper aerodigestive tract (Table 1) . The most common symptom reported by patients is a "lump in the throat" (globus sensation).[58] GERD is also called acid reflux or acid regurgitation, because digestive juices — called acids — rise up with the food. GERD occurs when stomach acid enters the esophagus, which is the tube that connects the throat with the stomach. This causes severe heartburn and could cause serious damage to the esophagus.[68] GERD makes stomach acid flow up into your esophagus. There is a valve at the lower end of the esophagus that is designed to keep acid in the stomach.[69] GERD occurs when the lower esophageal sphincter (LES) relaxes and allows the return of the stomach’s contents back up into the esophagus. Surgery to wrap the top of the stomach around the esophagus, called fundoplication, attempts to prevent LES relaxations in order to alleviate GERD symptoms.[70] GERD can lead to the reflux of fluid into the lungs; this can result in choking, coughing or even pneumonia. Some cases of adult-onset asthma, especially in those with no history of allergies or childhood asthma, can be traced to GERD.[71] Severe hypercalcemia, a potentially life-threatening condition, was reported in a pregnant woman with excessive ingestion of absorbable calcium antacid. She was treated and the child was delivered a month later with an uncomplicated neonatal course (Kleinman et al., 1991). Several randomized studies reported that a partial fundoplication can reduce the incidence of post-operative dysphagia. However, this benefit is off-set by an increase in the incidence of recurrence.[73]
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