Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. The endoscope helps your provider see inside your esophagus and stomach. Test results may not show problems when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications.
Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus. This can cause heartburn and other signs and symptoms. Frequent or constant reflux can lead to GERD.
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Gastroesophageal reflux disease (GERD) occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.
That's the muscle that controls the passage between the esophagus and stomach, and when it doesn't close completely, stomach acid and food flow back into the esophagus. The medical term for this process is gastroesophageal reflux; the backward flow of acid is called acid reflux. Acid reflux can cause sore throats and hoarseness, and may literally leave a bad taste in your mouth.
Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus. Gastroesophageal reflux disease (GERD) is a more severe and long-lasting condition in which GER causes repeated symptoms or leads to complications over time.
Your doctor may recommend that you make lifestyle changes and take medicines to manage symptoms of gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD). In some cases, doctors may also recommend surgery.
Fundoplication. Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term improvement of GERD symptoms. During the operation, a surgeon sews the top of your stomach around the end of your esophagus to add pressure to the lower esophageal sphincter and help prevent reflux.
Getting a case of acid reflux (heartburn) once in a while isn't unusual, but some people suffer from burning discomfort, bloating and belching almost every time they eat. About 20% of the population has gastroesophageal reflux disease (GERD), a chronic acid reflux condition that's diagnosed by a doctor.
Normally, the esophageal sphincter (a muscular tube that lets food pass into the stomach and then cinches shut to block it from coming back up) protects the esophagus from stomach acid. However, if the sphincter relaxes, food can push upward through the loosened opening and cause acid reflux.
"Diet plays a major role in controlling acid reflux symptoms and is the first line of therapy used for people with GERD," says Ekta Gupta, M.B.B.S., M.D., gastroenterologist with Johns Hopkins Medicine.
Foods fall somewhere along the pH scale (an indicator of acid levels). Those that have a low pH are acidic and more likely to cause reflux. Those with higher pH are alkaline and can help offset strong stomach acid. Alkaline foods include:
While there isn't enough research to prove that drinking apple cider vinegar works for acid reflux, many people swear that it helps. However, you should never drink it at full concentration because it's a strong acid that can irritate the esophagus. Instead, put a small amount in warm water and drink it with meals.
If you have heartburn two or more times a week and changes to your diet or eating pattern haven't helped, consult a doctor. A gastroenterologist (a doctor who specializes in the digestive system) can perform tests to measure the acidity in your stomach and see if frequent acid reflux has damaged your esophagus.
GERD is often treatable through a combination of lifestyle changes and medication. But persistent symptoms of reflux need thorough evaluation by a gastroenterologist who can find the underlying cause and discuss available treatment options.
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Postoperative dysphagia, with or without reflux symptoms, can also complicate laparoscopic repair.32 Final success rates range from 90% to 100%, and follow up in most (retrospective) series does not exceed one year. In a prospective randomised trial of laparoscopic versus open Nissen fundoplication Watson et al observed no difference in relief of symptoms at three months.33
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Gastroesophageal reflux disease (GERD) is a condition that develops when there is a retrograde flow of stomach contents back into the esophagus. It can present as non-erosive reflux disease or erosive esophagitis. This activity illustrates the evaluation and treatment of GERD and highlights the role of the interprofessional team in improving care for patients with this condition.
Objectives:Explain the pathophysiology of gastroesophageal reflux disease.Describe the signs and symptoms of a patient with gastroesophageal reflux disease.Describe the tests used to diagnose gastroesophageal reflux disease.Describe the importance of improving coordination among interprofessional team members to enhance the delivery of care for patients with gastroesophageal reflux disease.Access free multiple choice questions on this topic.
Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder characterized by the regurgitation of gastric contents into the esophagus. It is one of the most commonly diagnosed digestive disorders in the US with a prevalence of 20%, resulting in a significant economic burden in direct and indirect costs and adversely affects the quality of life[1][2]. GERD is caused by multiple different mechanisms that can be intrinsic, structural, or both, leading to the disruption of the esophagogastric junction barrier resulting in exposure of the esophagus to acidic gastric contents. Clinically, GERD typically manifests with symptoms of heartburn and regurgitation. It can also present in an atypical fashion with extra-esophageal symptoms such as chest pain, dental erosions, chronic cough, laryngitis, or asthma[3][4]. Based on endoscopic and histopathologic appearance, GERD is classified into three different phenotypes: non-erosive reflux disease (NERD), erosive esophagitis (EE), and Barrett esophagus (BE)[5]. NERD is the most prevalent phenotype seen in 60-70% of patients followed by erosive esophagitis and BE seen in 30% and 6-12% of patients with GERD, respectively. [1][5][6]. Over the years, the mainstay in the management of GERD has been lifestyle modifications, and proton pump inhibitors (PPIs). However, medically refractory GERD is becoming increasingly common, requiring a tailored approach in the management of GERD.
GERD is one of the most common gastrointestinal disorders, with a prevalence of approximately 20% of adults in western culture. A systematic review by El-Serag et al. estimated the prevalence of GERD in the US between 18.1% to 27.8%. However, the true prevalence of this disorder could be higher because more individuals have access to over-the-counter acid, reducing medications[2][13][2]. The prevalence of GERD is slightly higher in men compared to women[14]. A large meta-analysis study by Eusebi et al. estimated the pooled prevalence of GERD symptoms to be marginally higher in women compared with men (16.7% (95% CI 14.9% to 18.6%) vs. 15.4% (95% CI 13.5% to 17.4%)[12]. Women presenting with GERD symptoms are more likely to have NERD than men who are more likely to have erosive esophagitis[15]. However, men with longstanding symptoms of GERD have a higher incidence of Barrett's esophagus (23%) compared to women (14%)[16].
The pathophysiology of GERD is multifactorial and is best explained by various mechanisms involved, including the influence of the tone of the lower esophageal sphincter, the presence of a hiatal hernia, esophageal mucosal defense against the refluxate and esophageal motility.
The LES is a 3-4 cm tonically contracted smooth muscle segment located at the esophagogastric junction (EGJ) and, along with the crural diaphragm forms the physiological EGJ barrier, which prevents the retrograde migration of acidic gastric contents into the esophagus[17]. In otherwise healthy individuals, LES maintains a high-pressure zone above intragastric pressures with transient relaxation of the LES that occurs physiologically in response to a meal facilitating the passage of food into the stomach. Patients with symptoms of GERD may have frequent transient LES relaxations (TLESRs) not triggered by swallowing, resulting in exceeding the intragastric pressure more than LES pressures permitting reflux of gastric contents into the esophagus[18]. The exact mechanism of increased transient relaxation is unknown, but TLESRs account for 48-73% of GERD symptoms[19]. The LES tone and TLESRs are influenced by factors such as alcohol use, smoking, caffeine, pregnancy, certain medications like nitrates, and calcium channel blockers [18].
Hiatal hernia is frequently associated with GERD and can exist independently without causing any symptoms. Nonetheless, the presence of hiatal hernia plays a vital role in the pathogenesis of GERD as it hinders the LES function[20]. Patti et al. reported that patients with proven GERD with or without a small hiatal hernia had similar LES function abnormalities and acid clearance. However, patients with large hiatal hernias were noted to have shorter and weaker LES resulting in increased reflux episodes. It was also pointed out that the degree of esophagitis was worse in patients with large hiatal hernias[21]. A study evaluating the relationship between hiatal hernia and reflux esophagitis by Ott et al. demonstrated the presence of hiatal hernia in 94% of patients with reflux esophagitis [22]. be457b7860
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