A Simple Guide to Gastroesophageal reflux disease

A Simple Guide to Gastroesophageal reflux disease I
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What is Gastroesophageal reflux disease?
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Gastroesophageal reflux disease (GERD) is a chronic disease of the esophagus whose mucosa is damaged by abnormal reflux of gastric acid from the stomach to the esophagus.


What are the risk factors in Gastroesophageal reflux disease?
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1.Incompetant Lower Esophageal Sphincter(LES) allow the acid and gastric juice to reflux up the esophagus

2.Hiatus hernia - hole in diaphragm separating esophagus from stomach is enlarged allowing the easier flow of acid up the esophagus

3.Obesity and pregnancy: increased body weight cause pressure in the abdomen to push gastric contents upwards towards esophagus

4.Zollinger-Ellison syndrome- this condition typically increase gastric acid

5.Hypercalcemia, increase gastrin production, leading to increased acidity

6.Corticosteroids like prednisolone - can irritate the stomach mucosa and increase gastric acid

7.Scleroderma and Multiple sclerosis with esophageal involvement

Factors which has been associated with GERD :

8.Obstructive sleep apnea

9.Gallstones which can impede the flow of bile and digestion of fats


What are the causes of Gastroesophageal reflux disease?
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1.incompetence of the cardia(junction between the stomach and esophagus),

2.transient cardia relaxation,

3.impaired expulsion of gastric reflux from the esophagus

4.hiatus hernia.


What are the Symptoms of Gastroesophageal reflux disease?
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The most common symptoms are

1.Heartburn - there is a burning discomfort behind the breastbone due to acid flow up the esophagus

2.difficulty swallowing (dysphagia)- due to narrowing of the esophagus (persistent implies stricture while intermittent implies spasm)

3.chronic chest pain - pain is behind the central sternum as a result of acid in the esophagus

4.cough - the acid flow up the esophagus can irritate the larynx and spark off the cough reflex

5.hoarseness- due to inflammation of the vocal cords from the acid reflux

6.voice changes- as above

7.chronic ear ache- inflammation of the throat from acid relux an also affect the eustachian tube of the middle ear resulting in pain

8.burning chest pains- again due to the gastric acid in esophagus

9.nausea and belching- too much acid to the throat can cause the nausea and expulsion of air effect

10.sinusitis - acid can also find its way up the throat and into the sinuses.

11.esophagitis (reflux esophagitis)- acid low up the esophagus causing pain
worse on lying down

12.strictures are narrowing of the esophagus resulting from acid in the esophagus

If the reflux affects the throat and larynx, it is called laryngopharyngeal reflux disease.


How do you diagnose Gastroesophageal reflux disease?
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A detailed history of acid reflux into the esophagus.

Useful investigations may include

1.barium swallow X-rays,

2.esophageal manometry - measures the pressure in the esophagus

3.24-hour esophageal pH monitoring - measures the acidity of the esophagus

4.Esophagogastroduodenoscopy (EGD) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach in order to assess the internal surfaces of the esophagus, stomach, and duodenum.

In general, an EGD is done when:
1.the patient does not respond well to treatment,

2.has danger symptoms including:
dysphagia,

anemia,

blood in the stool (detected chemically),

wheezing,

weight loss,

voice changes.

Esophagogastroduodenoscopy can show peptic stricture, or narrowing of the esophagus near the junction with the stomach.
This can cause dysphagia or difficulty in swallowing

Biopsies done during gastroscopy may show:

1.Edema and basal hyperplasia (non-specific)
2.Lymphocytic inflammation (non-specific)
3.Neutrophilic inflammation (usually due to reflux or Helicobacter Gastroesophageal reflux disease)
4.Eosinophilic inflammation (usually due to reflux)
5.Goblet cell intestinal metaplasia or Barretts esophagus.
6.Elongation of the papillae
7.Thinning of the squamous cell layer
8.Dysplasia or pre-cancer.
9.Carcinoma.
10.Reflux changes may be non-erosive in nature, leading to the non-erosive reflux disease.