GASTRO-ESOPHAGEAL REFLUX DISORDER
WHAT IS GASTROESOPHAGEAL REFLUX?
This condition refers to the return of the stomach’s contents back up into the oesophagus. The lower oesophageal sphincter (LES) allows food to pass through to the stomach and closes to stop food and the acidic juices of your stomach from flowing back into your oesophagus.
Gastroesophageal reflux disease (GERD) occurs when your LES is weak or relaxes inappropriately, allowing the stomach’s content to flow up into the oesophagus. GERD affects your LES, stomach and the muscles between the oesophagus and stomach.
Many people including pregnant women suffer from heartburn or acid indigestion caused by GERD.
The severity of this disease depends on your LES dysfunction, the type and amount of fluid brought up from your stomach and the neutralizing effect of your saliva.
CAN GERD BE CURED?
In most cases, this condition can be relieved through diet and lifestyle changes. However, certain patients may require medication or surgery. Doctors believe that in some cases when people have this disorder, it is due to a condition known as hiatal hernia.
HOW DOES GERD LEAD TO CANCER?
Stomach acid splashes up into the lower portion of your oesophagus where there is no protective lining. This means that the acid can damage the tissue cells in your oesophagus. People who experience frequent acid reflux have a slightly increased risk for developing oesophageal cancer.
Tissue damage from this disease can sometimes lead to a pre-cancerous condition known as Barrett’s oesophagus.
WHAT IS BARRETT’S OESOPHAGUS?
The lining in your oesophagus replaces its own tissues with those, similar to the intestinal lining. These cells can sometimes develop into pre-cancerous cells.
Although it is associated with an increased risk of cancer, the majority of people with this condition will never develop oesophageal cancer. However, those who have both GERD and Barrett’s oesophagus are more likely to develop oesophageal cancer.
The most common symptoms include:
- Chronic heartburn
- Acid regurgitation
Less common symptoms that may be associated with GERD include:
- Difficulty or pain when swallowing
- Sudden excess of saliva
- The sensation of food sticking in the oesophagus
- Sore throat (chronic)
- Gum inflammation
- Erosion of teeth enamel
- Hoarseness in the morning
- A sour taste
- Bad breath
HEARTBURN OR GERD?
Almost everyone gets heartburn every now and again but remember, heartburn is also the most common symptoms of GERD. Speak to your doctor if your heartburn:
- Occurs 2 or more times a week
- Occurs at night and wakes you up from sleep
- Occurs every now and again for several years
- Causes you pain or difficulty when swallowing
- Caused you discomfort or pain interferes with your daily activities
_TREATMENT OPTIONS FOR GERD
Normally, the treatments for heartburn and other signs and symptoms start with over-the-counter medications that control acid. If you do not experience relief within a few weeks, your doctor may recommend other treatments as described below.
- Antacids that neutralize stomach acid:
They may provide quick relief but just antacids alone will not heal an inflamed oesophagus damaged by stomach acid. They include:
Overuse of some antacids can cause side effects, such as:
- Medications to reduce acid production:
Known as H-2-receptor blockers, they don’t react as quickly as antacids do but they provide longer relief and may also decrease production from the stomach for up to 12 hours. These medications include:
- Cimetidine (Tagamet HB),
- Famotidine (Pepcid AC)
- Nizatidine (Axid AR)
- Ranitidine (Zantac)
Stronger versions of these medications are available in prescription form.
- Medications that block acid production and heal the oesophagus:
Proton pump inhibitors are stronger blockers compared to H-2-receptor blockers. They also allow time for damaged oesophageal tissue to heal. Over-the-counter proton pump inhibitors include:
- lansoprazole (Prevacid 24 HR)
- Omeprazole (Prilosec, Zegerid OTC)
If you need to take these medications for longer than two to three weeks or your symptoms are not relieved, speak to your doctor.
- Prescription-strength medications
Your doctor may recommend prescription-strength medications if your heartburn persists despite initial approaches. They may include:
- Prescription-strength H-2-receptor blockers:
- Prescription-strength cimetidine (Tagamet)
- Famotidine (Pepcid)
- Nizatidine (Axid)
- Ranitidine (Zantac)
- Prescription-strength proton pump inhibitors:
These medications are normally well tolerated. However, long-term use may be associated with a slight increase in risk of bone fracture and vitamin B-12 deficiency. These medications include:
- Esomeprazole (Nexium)
- lansoprazole (Prevacid)
- Omeprazole (Prilosec, Zegerid)
- Pantoprazole (Protonix),
- Rabeprazole (Aciphex)
- Dexlansoprazole (Dexilant)
- Medication to strengthen the lower oesophageal sphincter:
Baclofen may decrease the frequency of relaxations of the lower oesophageal sphincter. As a result, decrease gastroesophageal reflux.
It has less of an effect than proton pump inhibitors. However it might be used in severe reflux disease.
Baclofen can be associated with significant side effects, most commonly:
GERD medications are sometimes combined to increase effectiveness.
- Surgery and other procedures used if medications don’t help
Medication can control most GERD. However, in situations where medications are not effective or you wish to avoid medication use, your doctor may recommend more-invasive procedures such as:
- Surgery to reinforce the lower oesophageal sphincter (Nissen fundoplication): To prevent reflux, the lower oesophageal sphincter is tightened by wrapping the top of the stomach around the outside of the lower oesophagus. This surgery is normally performed laparoscopically. The surgeon will make three or four incisions in the abdomen and instruments including a flexible tube with a tiny camera will be inserted through the incisions.
- Surgery to strengthen the lower oesophageal sphincter (Linx): This device is a ring of tiny magnetic titanium beads that is wrapped around the junction of the stomach and oesophagus. This device is implanted using minimally invasive surgery methods. It is strong enough to keep the opening between the stomach and oesophagus closed to refluxing acid but weak enough to allow food to pass through.
- History taking: GERD may be diagnosed based on complaints of frequent heartburns and other symptoms.
- Gastroscopy (Upper endoscopy): This enables your surgeon to visually examine the inside of your oesophagus and stomach. During the procedure, a thin flexible tube equipped with a light and camera is inserted through your throat.
A tissue sample (biopsy) may also be collected for further testing. This technique is useful in looking for complications of reflux such as Barrett’s oesophagus.
- A test to monitor the amount of acid in your oesophagus: An ambulatory acid (pH) probe test is used to measure acid for 24 hours. This device can identify when and for how long stomach acid regurgitates into your oesophagus. One type of monitor that is used is a thin, flexible tube (catheter) that’s threaded through your nose into your oesophagus. The tube is connected to a small computer that will be worn around your waist or with a strap over your shoulder.
Another test to monitor the condition is a clip that is placed in your oesophagus during endoscopy. This probe transmits a signal to a small computer that you wear. After about two days, the clip will fall off to be passed in your stool. You may be asked to stop taking GERD medications to prepare for this test.
- An X-ray of your upper digestive system: This procedure is sometimes known as barium swallow or upper GI. It involves drinking a chalky liquid that coats and fills the internal lining of your digestive tract. X-rays of your upper digestive tract is then taken. The coating allows your surgeon to see a silhouette of your oesophagus, stomach and upper intestine (duodenum).
- A test to measure the movement of the oesophagus: A test called the Oesophageal motility testing (manometry) is used to measure movement and pressure in the oesophagus. A catheter is inserted through your nose and into your oesophagus to measure the movements and pressure.