Gastroesophageal Reflux Disease (GERD)

Pathophysiology

This disease is described as a “chronic digestive disease that occurs when stomach acid, or occasionally bile flows back into the esophagus” (“GERD,” 2012). During the digestive process, we eat food and drink liquids, which travel from the mouth down the throat to the stomach by way of the esophagus or swallowing tube. When food enters the stomach, a “ring of muscle fibers prevents food from moving backward into the esophagus” (Jaret, 2011), this relaxation allows food and liquid to stream into the stomach and then closes. This happens when our digestive system is working properly, but when this ring, called the lower esophageal sphincter, LES, does not close completely, stomach acid, liquids, or food can seep back into the esophagus, creating gastroesophageal reflux. This “constant backwash of acid” leads to heartburn, breathing complications, bleeding, other GERD symptoms, or esophagus damage (“GERD,”2012). 

Presentation

Symptoms consist of heartburn, dry cough, chest pain, painful (odynophagia) or difficulty (dysphagia) swallowing, hoarseness, bleeding, “acid regurgitation” (“GERD,” 2013) or the “sensation of a lump in the throat” (“GERD,” 2012). Diagnosis consists of providers discussing symptoms with patients, an endoscopy test to examine the esophagus, an ambulatory acid test to check esophagus ph and acid levels, barium x-rays to review the upper digestive system and esophageal motility testing to measure esophagus pressure and movement (“GERD,” 2013).

Population

Approximately 20 percent of the U.S. population is affected by GERD (Kulkarni et al., 2013). Risk factors include being obese, pregnant, smoking, scleroderma, alcohol consumption, patients with respiratory conditions, such as asthma, as well as a “hiatal hernia, a condition in which part of the stomach moves above the diaphragm” (Jaret, 2011). Some genetic case studies have also shown evidence of hereditary significance. Medications taken for heart disease, high blood pressure, asthma, Parkinson’s disease, antidepressants, birth control, or seasickness, along with pregnancy can often bring about these symptoms or make them worse. 

Patient Management

Lifestyle changes such as avoiding late-night eating, losing weight, reducing alcohol consumption, along with smoking cessation are great first steps. Patient medications producing these symptoms must also be reviewed for elimination or new choices. Taking antacids purchased over-the-counter after a meal, or a prescription can aid as well. Prescription medications include H2 blockers, which reduce stomach acid production or proton pump inhibitors, PPIs, which heal the esophagus by blocking stomach acid production. Fundoplication surgeries are used to reinforce the lower esophageal sphincter, along with surgeries to prevent the backup of stomach acid by folding a tissue at the stomach base (“GERD,” 2012). 

Prognosis

Most patients have success with lifestyle changes. Small groups of the patient require continuous medication for heartburn relief. Management of symptoms is critical, as GERD can lead to added complications of esophageal ulcer, dental problems, chronic cough, respiratory diseases, stricture (scar tissues which create a narrower esophagus), along with Barrett’s esophagus, a possible pre-cancerous condition of lining discoloration (“GERD,” 2012).

References

Gastroesophageal Reflux Disease (GERD) [Conditions and Treatments]. (2013). Retrieved from American Academy of Allergy, Asthma & Immunology website: http://www.aaaai.org/conditions-and-treatments/related-conditions/gastroesophageal-reflux-disease.aspx

GERD [Health Information]. (2012, April 13). Retrieved from Mayo Clinic website: http://www.mayoclinic.com/health/gerd/DS00967

Jaret, P. (2011, August 11). A sigh of relief for heartburn sufferers. The New York Times. Retrieved from http://health.nytimes.com/health/guides/disease/gastroesophageal-reflux-disease

Kulkarni, G. V., Herbella, F. A., & Fisichella, P. M. (2013, April 23). Gastroesophageal reflux disease. Gastroenterology Research and Practice, 2013, 2. Retrieved from http://www.hindawi.com/journals/grp/2013/760750/