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REFLUX AND HEARTBURN
Learn more about gastroesophageal reflux disease (GERD)

 

 

WHAT IS GERD?

 

 

The esophagus has several muscular rings (sphincters) that contract and prevent the passage of stomach contents back into the esophagus.1

When the gastric content is returned from the stomach to the esophagus recurrently, it is considered that the person may be suffering from Gastroesophageal Reflux Disease (GERD), it means that the patient might be having complications resulting from the Reflux of gastric contents in the esophagus or beyond, in the oral cavity.2

 

 

SYMPTOMS3

 

  • Sore throat
  • Acidity
  • Hoarseness
  • Acid regurgitation
  • Burning in the chest or upper part of the stomach
  • Persistent vomiting
  • Bad breath
  • Respiratory problems (asthma)

 

 

RISK FACTORS ASSOCIATED WITH GERD

 

 

Several factors that produce increased pressure in the abdominal cavity or relaxation of the lower esophageal sphincter can contribute to the development of reflux, among which can be mentioned:3

  • Obesity
  • Pregnancy
  • Hiatal hernia
  • Smoking
  • Eating very late at night
  • Consumption of drinks such as alcohol or coffee
  • Consumption of very spicy or fatty foods

 

 

HOW IS IT DIAGNOSED?

 

 

The diagnosis of GERD (Gastroesophageal Reflux Disease) must be made strictly by a doctor. Usually the disease can be detected only with the symptoms that the patient refers, however, the doctor is the one who will decide if the information provided by the patient is the only one to consider or not for the diagnosis, or if they required to perform one or more confirmatory tests.4       

These tests in addition to confirming the condition are useful for the health team or your doctor to confirm or rule out GERD-related complications and even select the best treatment.

 

WHAT TESTS CAN BE USE TO DIAGNOSED GERD?

Diagnostic tests are used to confirm or rule out GERD. One of them consists of a therapeutic test with a proton pump inhibitor (PPI) or another medicine to treat the disease. It correlates with a diagnosis of GERD, if symptomatic relief occurs after two weeks of treatment with a PPI. Other tests 4

  • Endoscopy with or without biopsy
  • Esophageal manometry
  • Monitoring of esophageal pH
  • Wireless esophageal pH monitoring
  • Barium X-ray

 

ENDOSCOPY

An endoscopy, also known as gastroscopy, is a procedure performed by a gastroenterologist, using an instrument consisting of a thin, long, flexible tube with a camera on its end that allows the doctor to observe and examine the internal part of the upper digestive tract, that is, esophagus, stomach, and upper part of the small intestine.5 The procedure is performed under sedation for patient's comfort.

By means of endoscopy with or without biopsy (taking a small tissue sample) it is possible to detect complications such as esophagitis (inflammation of the esophagus), peptic stricture or Barrett's esophagus.5

 

ESOPHAGEAL MANOMETRY 

It is a technique where the pressure of the esophagus and the lower esophageal sphincter is measured with the aim of looking for alterations of esophageal motility. During the procedure, a thin tube is inserted through the nose into the esophagus. The probe is connected to an apparatus that records the contractions that produce the esophagus from the throat to the esophagus.1

 

MONITORING OF ESOPHAGEAL PH

Esophageal pH monitoring uses a thin tube that is inserted through the nose into the esophagus or wirelessly in which a wireless pH capsule is placed in the lower part of the esophagus during endoscopy. The pH monitoring time by means of a probe is 24 hours from the moment it is placed, in the case of using a wireless monitor with a capsule, the time it remains time is 48-96 hours.4 This test provides data on the levels of acidity in the lower esophagus and allows the study of a potential correlation of reflux with symptoms.6

You can perform your normal daily activities unless the doctor indicates otherwise. To obtain accurate results, it is important that you ask your doctor what medications or foods you may or may not consume before undergoing the tests.4

BARIUM X-RAY

Barium radiography consists of a test where images of the esophagus, stomach, duodenum and small intestine are taken by means of X-rays. For the test you must take a quantity of barium duly administered by qualified personnel. With the results obtained, a diagnosis or more specific treatments can be determined.4

 

HOW TO PREPARE FOR AN ENDOSCOPY

You will receive written instructions from your doctor about how to prepare for your procedure.

You can consider the following list of tips7:

  • Do not consume solid foods 12 hours before your procedure.

  • You can drink only clear liquids up to 4 hours before your procedure.

  • If you take medications, do so no later than 4 hours before your procedure and using small sips of water.

  • Do not use any type of antacid before the procedure.

  • Ask a family member, friend or responsible adult to be your company when leaving the endoscopy.

  • Do not drive after the procedure. It is recommended that you take the day off and rest after your procedure, this includes not doing any type of physical exercise.

 

WHAT HAPPENS IN GASTROESPHAGEAL REFLUX DISEASE (GERD) ?

 

When the valve between the stomach and the esophagus, called the lower esophageal sphincter, does not close properly, the contents of the stomach flow  into the esophagus.8

This disease arises when there is an imbalance between the normal mechanisms of the esophagus and offensive factors such as acid juices and other stomach digestive enzymes. The lower esophageal sphincter is a muscle that often weakens, so the barrier between the esophagus and stomach is affected.8

Among the causes that can also be considered the hernia of the hiatus in which a part of the stomach is displaced towards the chest. However, many people who have a hiatus hernia do not suffer from GERD.8

Obesity is considered a trigger for the onset of reflux since the increase in pressure in the abdomen exceeds the barrier between the stomach and the esophagus.8

 

 

References

1. Bredenoord, A., & Gyawali , C. (2018). Esophageal motility disorders. Techniques in Gastrointestinal Endoscopy, 98-106.

2. Sandhu , D., & Fass, R. (2018, Enero). Current Trends in the Management of Gastroesophageal Reflux Disease. Gut and Liver, 12(1), 7-16.

3. National Institute of Diabetes and Digestive and Kidney Diseases. (2015, noviembre). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/all-content#section2

4. The American Gastroenterological Association. (2017, julio). The American Gastroenterological Association. Retrieved from www.gastro.orl

5. Gyawali, C., Kahrilas, P., Savarino, E., Zerbib, F., Mion, F., Smout, A., . . . Roman, S. (2018). Modern diagnosis of GERD: the Lyon Consensus. GUT, 1351-1362.

6. Bazin, C., Benezech, A., Alessandrini , M., Grimaud, J.-C., & Vitton, V. (2018). Esophageal Motor Disorders Are a Strong and Independant Associated Factor of Barrett’s Esophagus. Journal of Neurogastroenterology and Motility , 216-225.

7. Stanford Health Care. (2019). Stanford Medicine. Retrieved from https://stanfordhealthcare.org/medical-treatments/e/endoscopy/what-to-expect.html

8. American Society for Gastrointestinal Endoscopy. (2018). Cómo comprender la Enfermedad del Reflujo Gastroesofágico. Retrieved from https://www.asge.org/home/for-patients/patient-information/c%C3%B3mo-comprender-la-enfermedad-del-reflujo-gastroesof%C3%A1gico