Reflux
Also known as: Heartburn, gastroesophageal reflux
disease, (GERD), "reflux", or acid
reflux.
What is it?
Gastroesophageal reflux is also
sometimes referred to as acid reflux.
It is a disorder where the acid
contents of the stomach flow back
(reflux) into the esophagus. The
esophagus is the tube that connects the
throat and stomach.
However, the esophagus doesn’t
have a protective lining like the
stomach, so the acid from
gastroesophageal reflux causes the lower
part of the esophagus to become inflamed
and painful.
This condition is called reflux
esophagitis.
Who
gets it?
Anyone can suffer
from gastroesophageal reflux, but it is
more likely to affect people who are
obese, have a hiatal hernia, experience
recurrent vomiting, or have scleroderma.
Gastroesophageal reflux may also occur
during pregnancy, or in those who have
nasogastric tubes.
What
causes it?
Acid refluxes from
the stomach when the lower esophageal
sphincter (LES) isn’t working properly.
This sphincter is usually tightly closed and opens only when
food passes from the esophagus into the
stomach.
In addition to the conditions
listed under “Who gets it?”, there are
a number of factors that can cause the LES
to open and let stomach acids reflux.
These include eating very large
meals, lying down within two to three
hours of eating, and taking certain drugs
including diazepam, meperidine,
theophylline, morphine, prostaglandins,
calcium channel blockers, nitrate heart
medications, and anticholinergic and
adrenergic drugs.
If you are prone to acid reflux,
eating greasy foods and foods such as
chocolate and peppermint can also relax
the LES.
Caffeine, alcohol, and nicotine may
also aggravate acid reflux.
What are the symptoms?
The main symptom of gastroesophageal
reflux is heartburn. Other symptoms
include cramping, difficult or painful
swallowing, pain behind or just below
the breastbone, spitting up at night,
excessive salivation, sore throat,
hoarseness, coughing, shortness of
breath, bad breath, and fluid or vomit
inhaled into the lungs. Symptoms can
appear when you lie down after eating,
but are relieved by sitting up. Heartburn
can be severe and spread to your neck,
jaw, arms, and back.
People with heartburn frequently
regurgitate stomach contents into their
mouths, leaving a bitter taste. If
gastroesophageal reflux occurs
frequently, it can lead to reflux
esophagitis, esophageal narrowing,
esophageal ulcer, and Barrett’s
syndrome, which is a change in the
lining of the esophagus that can lead to
esophageal cancer.
How
is it diagnosed?
Your doctor will take
a complete medical history and review your
symptoms.
He or she may refer you to a
gastroenterologist.
Tests used for diagnosis include
x-rays, which are taken after a patient
drinks a barium solution and lies down
with the head lower than the feet, and
esophagoscopy, where a flexible viewing
tube is inserted into the esophagus for a
close examination. A
tissue sample (biopsy) may be taken during
this test and studied for Barrett’s
syndrome.
Other tests include esophageal manometry, which measures
pressure in the lower esophageal
sphincter, and the Bernstein test, which
measures the acidity in the esophagus.
What is the
treatment?
The main goal of
gastroesophageal reflux treatment is the
relief of symptoms and prevention of
relapses.
For mild cases, your doctor may
prescribe antacids to take after meals and
at bedtime.
It may also be helpful to raise the
head of your bed to keep the acid flowing
away from the esophagus while you sleep.
Your doctor may advise you to avoid
fatty foods and drinks such as coffee and
alcohol that can aggravate this condition.
There are drugs called histamine
receptor blockers that help to reduce
stomach acids.
Some people find that proton-pump inhibitors are more
effective at inhibiting acid production
than the histamine receptor blockers.
There are also drugs, called
prokinetic or motility drugs, that make
the lower esophageal sphincter close more
tightly. Additional
drug therapy, including omepraxole or
lansoprazole, can quickly heal esophageal
inflammation. A
narrowed esophagus is treated with drug
therapy and dilation. Surgery is only
recommended if the symptoms don’t
respond to other treatments.
Less than 25% of people with
gastroesophageal reflux require surgery.
Surgical Treatment
During the minimally invasive
"reflux" procedure, our specialists use
pencil-thin cameras to see a detailed picture of
your body. From there, they insert other
tiny instruments through small incisions into the
body to surgically correct the disorder. A
new, more effective esophageal "valve"
is created by wrapping the stomach around the
esophagus. The surgery is called
Laparoscopic Nissen Fundoplication.
Since the procedure is performed
through dime-size incisions, minimally invasive
surgery is easier on you. Smaller incisions
and less disruption inside the body mean less
discomfort, a shorter hospital stay and faster
recovery. The small incisions also provide
better cosmetic results.
Patients who undergo the
procedure report immediate relief from painful
heartburn, regurgitation, hoarseness, chronic
coughing, and swallowing difficulties. Most
patients see these improvements while stopping
all medications for reflux including antacids, H2
blockers, proton-pump inhibitors, and
pro-motility medications. And...they can
eat foods that they have not dared to try for
years!
We are committed to improving
your health
Taking a team approach to care,
we work closely with patients' physicians and
gastroenterology specialists to provide
comprehensive care.
A thorough medical evaluation is
necessary prior to surgery. The evaluation
may include an upper gastrointestinal x-ray and
an upper gastrointestinal endoscopy as well as
tests that measure pressure and function of the
esophagus and stomach.
You can expect to go home one or
two days after the surgery. Together with
your physician, we will provide follow-up care
until you are fully recovered.
Self-care
tips
If
you have been diagnosed gastroesophageal
reflux disease (GERD), follow your
doctor’s instructions for care and
treatment.
Maintain a healthy diet, exercise
regularly, and avoid eating large meals,
drinking alcohol, and smoking cigarettes.
Wearing clothing that fits loosely around the stomach
can help stop stomach acids from
refluxing.
You can help prevent
gastroesophageal reflux by eating
frequent, small meals; remaining upright
for at least 3 hours after meals; and
avoiding stress during meals or soon after
eating.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
|
