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Gastroesophageal reflux: from causes to effective treatment
Gastroesophageal reflux - what is it?
Gastroesophageal reflux is a condition that occurs when stomach contents back up into the esophagus, which can lead to a variety of symptoms. Although most commonly associated with heartburn, reflux is a complex problem that requires an understanding of both its mechanism and potential health consequences. In this article, we will take a closer look at this condition, starting with its definition and mechanism of action.
Gastroesophageal reflux - causes
The causes of gastroesophageal reflux are varied and include a number of factors, both lifestyle and medical conditions. Understanding these causes is key to effective treatment and prevention of this condition. Here are the main factors contributing to the development of gastroesophageal reflux:
Weakening of the lower esophageal sphincter (LES): The lower esophageal sphincter is a muscle located between the esophagus and stomach that regulates the flow of food content. Its weakness or malfunction can lead to backflow of stomach acids into the esophagus.
Diet: Eating fatty, spicy, acidic foods, as well as caffeinated drinks and alcohol can increase the risk of reflux. Large meals and eating before bedtime also promote the condition.
Obesity: Excess weight can increase abdominal pressure, which affects the function of the lower esophageal sphincter, making it easier for stomach contents to back up.
Smoking: The nicotine in cigarettes affects the function of the lower esophageal sphincter, promoting reflux.
Pregnancy: During pregnancy, hormonal changes and increased abdominal pressure can promote reflux in some women.
Diaphragmatic hernia: With adiaphragmatic hernia, part of the stomach can pass into the chest, increasing the risk of reflux.
Genetics: A tendency to reflux can be genetic, meaning there is a higher risk if there is a family history of the condition.
Esophageal muscle disorders: Abnormalities in esophageal muscle function, especially in what is known as peristalsis, can promote reflux.
Gastrointestinal diseases: Some diseases, such as systemic scleroderma or esophagitis, can affect the weakness of the lower esophageal sphincter.
Stress: Stress and emotional tension can affect the functioning of the digestive system, which can promote reflux.
Gastroesophageal reflux - the most commonly mentioned symptoms
Gastroesophageal reflux can manifest with a variety of symptoms that can affect a patient's comfort and quality of life. Below are the most commonly mentioned symptoms associated with gastroesophageal reflux disease:
Heartburn: This is one of the most characteristic symptoms of reflux. It consists of a burning or hot sensation behind the sternum, often in the heart area. Heartburn usually intensifies after meals, especially when bending over or lying down.
Regurgitation: This involves backflow of food contents or stomach acids into the throat, which the patient may experience as an unpleasant bitter sensation in the mouth.
Chestpain: These symptoms can resemble heart pain, which sometimes makes accurate diagnosis difficult. The pain usually intensifies after meals.
Epigastric discomfort and pain: Patients with reflux disease may experience pain, heaviness or discomfort in the upper abdomen, especially after eating.
Cough: A prolonged, persistent cough, especially at night, may be associated with reflux disease, especially if there are no other symptoms of respiratory infection.
Hoarseness: Irritation of the larynx by retreating food content can lead to hoarseness and changes in voice.
Swallowing problems: Weakening of the lower esophageal sphincter and irritation of the esophagus by stomach acid can cause difficulty swallowing.
Unusual oral symptoms: Some patients experience changes in the mouth, such as a metallic taste, a dry sensation or a burning sensation.
Lethargy and vomiting: For children and infants, reflux can manifest itself as frequent volatilization, vomiting, irritability and difficulty eating.
Sleep disturbances: Difficulty falling asleep, irregular awakenings at night and general sleep problems can be associated with reflux disorder.
Taste disorders: Changes in taste, especially after meals, may be the result of retreating food contents.
Breathing problems: For some patients, reflux can lead to irritation of the airways, which manifests as breathing problems, especially when lying down.
Gastroesophageal reflux - unusual symptoms
Gastroesophageal reflux can also manifest with atypical symptoms, which are sometimes difficult to identify as related to the condition. Here are some unusual symptoms that may be associated with gastroesophageal reflux disease:
Ear pain: Backflowing food contents can irritate the middle ear, which can manifest as pain or recurrent otitis media.
Irritability and mood changes: In some patients, reflux can affect the ability to concentrate, causing irritability, mood changes and even depressive symptoms.
Hoarsenessin infants: Infants with reflux disease may experience hoarseness and voice changes, which can be caused by irritation of the larynx.
Back and chest pain: Some patients experience back pain, which may be due to nerve irritation in the esophagus.
Night sweats: Some patients report night sweats, which may be related to nighttime backflow of food contents into the esophagus.
Persistentcough: Persistent coughing, especially when there are no symptoms of respiratory tract infection, may result from reflux of stomach acids into the airways.
Aphthous mouth: Refluxing food content can cause irritation in the mouth, which can manifest as the appearance of aphthas or ulcers.
Hoarsenessin children: Children with reflux disease may experience hoarseness, especially after eating.
Chronic throat problems: Reflux can cause chronic throat problems such as pain, dryness, a stinging or abrasive sensation.
Increased sweating: Patients with reflux disease may experience increased sweating, especially at night.
Dental problems: Stomach acid backing up into the mouth can lead to enamel erosion, which affects dental health.
Diagnosis of gastroesophageal reflux
Diagnosis of gastroesophageal reflux involves a set of various tests that help doctors confirm the presence of the condition, assess its severity and rule out other causes of symptoms. Below are the most common tests performed in the process of diagnosing gastroesophageal reflux:
Medical history (anamnesis): The doctor takes a thorough history of the symptoms, their severity, duration, and any triggers, such as diet or lifestyle.
Physical examination: The doctor performs a physical examination of the patient, assessing, among other things, the presence of any lesions in the mouth, throat, chest or abdomen.
Upper gastrointestinal endoscopy: This examination allows direct observation of the wall of the esophagus, stomach and the initial section of the duodenum. During endoscopy, tissue sections can also be taken for biopsy for further analysis.
Esophagealmanometry: This test evaluates the function of the lower esophageal sphincter by measuring the pressure in various parts of the esophagus during swallowing.
EsophagealpH-metry: This test measures the amount of acid in the esophagus over a specified period of time. The patient wears a thin tube (pH probe) for several days, and the data is recorded to assess the occurrence of reflux episodes.
Esophageal x-ray with contrast: The patient ingests a special contrast liquid, and a series of X-rays are taken, allowing observation of the movement of food content in the esophagus.
Blood tests: In some cases, the doctor may order blood tests to assess the patient's overall health and rule out other possible causes of symptoms.
Allergy tests: If a link between reflux disease and allergies is suspected, your doctor may recommend allergy tests.
Gastroesophageal reflux - treatment.
Treatment of gastroesophageal reflux is usually multistep and depends on the severity of symptoms and possible complications. Below are the general principles of treatment for this condition:
Lifestyle modifications:
Diet: Avoid foods and drinks that can increase stomach acid production, such as hot spices, fatty foods, chocolate, coffee and alcohol.
Avoiding large meals: Eating smaller, more frequent meals instead of three large meals a day.
Avoiding eating before bedtime: The last meal should be eaten at least 2-3 hours before bedtime.
Pharmacotherapy:
Proton pump inhibitors (PPIs): These are drugs that inhibit the production of gastric acid. Examples include omeprazole, esomeprazole, pantoprazole.
H2-receptor antagonists: Drugs that reduce the amount of acid secreted. Examples include ranitidine, famotidine.
Prokinetics: Drugs that promote esophageal peristalsis, speeding up the emptying of gastric contents. Examples include metoclopramide, domperidone.
Surgical treatment of reflux:
In the absence of effective pharmacological treatment or in the presence of severe complications, surgical intervention, such as fundoplication, may be considered.
Dietary changes:
Avoiding acids and pungent spices: Reduce the intake of acidic foods and drinks and pungent spices.
Increasing fiber intake: A diet rich in fiber can help reduce reflux symptoms by regulating digestion.
Reducing body weight:
In people who are overweight or obese, weight reduction can help reduce reflux symptoms.
Avoiding irritants:
Avoiding smoking and alcohol: Both of these substances can exacerbate reflux symptoms and make it more difficult to treat.
Reflux - diet and prevention
Diet and prevention play a key role in managing gastroesophageal reflux disease. Here are some dietary principles and preventive measures that can help relieve reflux symptoms and prevent recurrence:
Diet for gastroesophageal reflux:
Avoiding acidic foods: Citrus fruits, tomatoes, orange juice or coffee can increase stomach acidity, which contributes to the severity of reflux symptoms.
Limit fatty foods: Fatty foods, such as French fries or fried meat, can slow gastric emptying, which increases the risk of reflux.
Avoiding spicy and hot foods: Spices such as bell pepper, paprika and garlic can irritate the esophagus, exacerbating the discomfort.
Avoiding chocolate: Chocolate contains substances that can weaken the lower esophageal sphincter, promoting backflow of gastric contents.
Limit caffeine and alcohol: Caffeine and alcohol can increase gastric acid production, so it's a good idea to limit their intake.
Avoid carbonated beverages: Carbonated beverages can increase pressure in the stomach, increasing the risk of reflux.
Eating regular meals: Eating smaller, regular meals can help balance the stomach and avoid excessive pressure on the lower esophageal sphincter.
Avoiding eating before bedtime: The last meal should be eaten at least 2-3 hours before bedtime to avoid backflow of gastric contents into the esophagus while lying down.
Positioning your head while sleeping: If you are prone to reflux, it is a good idea to elevate your pillow a few inches, which can help reduce nighttime reflux symptoms.
Gastroesophageal reflux prevention:
Maintaining a healthy body weight: Obesity and overweight are risk factors for reflux, so maintaining a healthy body weight can help reduce symptoms.
Avoiding smoking: Smoking weakens the lower esophageal sphincter, which increases the risk of reflux. Smoking cessation is key to prevention.
Regular physical activity: Regular physical activity aids digestion and accelerates gastric emptying, which can reduce the risk of reflux.
Avoiding wearing tight clothing: Wearing tight clothing can put pressure on the stomach and increase the risk of reflux.
Managing stress: Stress can exacerbate reflux symptoms, so it's a good idea to use relaxation techniques like meditation or yoga.
Avoiding lying down after eating: After eating, it's a good idea to stay seated or standing for at least 2-3 hours before going to bed.
Adopting healthy eating and living habits can make a significant difference in controlling gastroesophageal reflux and improving patient comfort. However, it is worth remembering that each case of reflux is individual, so it is always a good idea to consult a doctor before making significant changes.
Summary
A complete cure for gastroesophageal reflux can be difficult, but effective symptom management and the use of appropriate therapies and lifestyle changes can significantly improve a patient's quality of life. In many cases, with appropriate treatment and management, reflux sufferers can achieve long-term remission of symptoms.
Bibliography
"Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management" - Editor: Mark Feldman, Lawrence S. Friedman, Lawrence J. Brandt. Published by Saunders; 10th Edition (2015).
Yamada's Textbook of Gastroenterology" - Editor: Daniel K. Podolsky, Michael Camilleri, J. Gregory Fitz, Anthony N. Kalloo. Publisher: Wiley; 6th Edition (2015).
Gastroesophageal Reflux Disease: Principles of Disease, Diagnosis, and Treatment." - Author: Frank Alexander Granderath. Published by Springer; 2015.
Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy" - Editor: Norton Greenberger, Richard Blumberg, Robert Burakoff. Published by McGraw-Hill Education / Medical; 2nd Edition (2012).
The Little GI Book: An Easily Digestible Guide to Understanding Gastroenterology" - Author: Douglas G. Adler. Published by SLACK Incorporated; 2013.