Your oesophagus is the tube that carries food from your mouth to your stomach, gastroesophageal reflux disease,GERD or acid reflux happens when a muscle at the end of your oesophagus does not close properly. This allows stomach contents to lean back or reflux into the oesophagus and irritated. You may feel a burning in the chest or Cold heartburn. Sometimes you can taste stomach, fluid in the back of the mouth. If you have these symptoms more than twice a week, you may have GERD. Let’s check acid reflux causes, symptoms& management
You can also have GERD without having heartburn, your symptoms, good included, a dry cough, asthma symptoms or trouble swallowing. Anyone including infants and children can have GERD if not treated, it can lead to more serious health problems. In some cases you might need medicines or surgery.
However many people can improve their symptoms by avoiding alcohol and spicy fatty or acidic foods that trigger heartburn. Eating smaller meals, not eating close to bedtime losing weight. If needed and wearing loose-fitting clothes.
Also read :GERD Important notes
Pathophysiology
- Imbalance between esophageal exposure to acid and compensatory mechanisms
- LES Insufficiency
- Normal resting pressure 12–30 mm Hg
- Normally relaxes in response to peristalsis to accept incoming food/liquid
- bolus
- Reflux: transient relaxation of the LES
- Hiatal Crura and Hiatal Hernia
- Hiatal crura are the other major antireflux barriers along with LES
- Additional barriers
- Length of intra-abdominal esophagus: ideally >2 cm
- Phrenoesophageal membrane
- Angle of His
- Hiatal hernias (see below) magnify the degree of GERD symptoms
Clinical Features of acid reflux
- Symptoms: substernal burning in the chest,
- regurgitation of food
- acid taste in mouth, dysphagia,
- hoarseness, cough, wheezing, and aspiration
- Exacerbating factors: worse with food or certain types of food; worse when lying flat or at night; or stressful situations
- Relieving factors: proton pump inhibitors (PPI), H2 blockers;
- use of pillows, sitting up at night
- Signs: often few, may have loss of dental enamel
Diagnosis of GERD or acid reflux
Barium swallow: reveals anatomy, presence of hiatal hernias, location
of GE junction in relation to hiatus, and can asses peristaltic
function
Endoscopy: reveals the presence of esophageal erosions,strictures, hiatal hernias.
Barrett’s esophagus: salmon-colored mucosa—must be biopsied as it
is a premalignant lesion.
24-hour pH monitoring: confirms GERD (sensitivity 80–90%)
Details number and duration of episodes of reflux Correlates subjective symptoms with events
Positive test: >6% of the time with a pH <4 (1.5 hours),
Demeester score >14.7
Note: H2 blockers need to be held for at least 3 days prior and PPIs
for at least 1 week prior to test due to irreversible parietal cell
inhibition
Manometry: assesses location, length, pressure of LES, ability of LES
to relax with swallowing, and amplitude of peristalsis of esophageal
body
With disordered peristalsis some will not perform a Nissen
fundoplication, but will do a partial wrap instead.
Acid reflux: Management
Treatment of GERD the Mainstay for medical therapy are acid blockers. And there are two main types hiss me tune receptor blockers. Commonly called H2 blockers,
And the other main type are proton. Pump inhibitors, commonly refer to as ppis. Ppis are considered the stronger of the two. There are also antacids. Which aren’t as effective, but I will mention these briefly as well. Now different, Physicians customize, which of these acid blockers to prescribe you based on your personal symptoms, the medications we will go over in this video all work by reducing acid exposure, in your esophagus, but do not prevent the action of reflux itself. Now let’s talk a little bit more about acid blockers. Histamine, 2 receptor blockers or H2 blockers.
Work by blocking certain receptors in certain cells in your stomach that cause them to produce less acid with less acid in your stomach. There’s less irritation of the esophagus. When stomach acid does reflux up from the stomach into the esophagus in patients, whose symptoms are relatively minor meaning, less than two episodes of reflux a week and who are already trying, we’re have failed lifestyle modifications, it’s common to see.
H2 blockers used some combination of blockers include famotidine who is Market name is Pepcid Ranitidine. Whose Market name is Zantac Adenine,Market name is axid.Cimetidine, Market name is Tagamet. Blockers are commonly prescribed twice a day. Once in the morning. And again, either before dinner or before bedtime, they work best if they’re taken 30 minutes before meals