Gastroesophageal Reflux Disease
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease is a disease in which gastric acid returns to the esophagus and causes variety of problems. Esophagus is a tubular organ that transfers swallowed food to the stomach. Its inner surface is formed by a mucous membrane composed of several layers of cells. The cells are adapted to the esophageal environment and are resistant to possible damage resulting from the passage of food. The lining of the stomach, on the other hand, is formed by a different type of cells that can better withstand permanent acidity of gastric juices. The boundary between these two types of cells is distinct and is called the Z-line. Gastroesophageal reflux disease is a common disease; its symptoms are very annoying for the patient.
Development of Gastroesophageal Reflux Disease
Gastroesophageal reflux disease means return of gastric contents into the esophagus with all its consequences. To certain point, gastroesophageal reflux is a normal condition. If defensive mechanisms of the esophageal mucous membrane are working properly, no problems arise. These defensive mechanisms include the influence of gravitation, peristaltic movements of the esophagus and reaction of saliva. If the defensive mechanisms of the esophagus or the lower esophageal sphincter do not work properly, gastroesophageal reflux disease develops. Lower esophageal sphincter is located between the esophagus and the stomach. Its malfunction causes excessive leakage of gastric acid into the esophagus and the mucous membrane of the lower esophagus becomes inflamed. Gastroesophageal reflux disease may also be caused by lack of mobility of the stomach or by a change in its position.
Risk Factors for Gastroesophageal Reflux Disease
Risk factors for gastroesophageal reflux disease contribute to the malfunction of the lower esophageal sphincter and thus support the emergence of the gastroesophageal reflux. The main risk factors include a diet rich in fat, obesity, smoking, specific food such as onions, garlic, fresh pastries and chocolate. Also some medicaments may contribute to the poor lower esophageal sphincter function; for example anesthetics, prostaglandins, progesterone, beta blockers, dopamine, and opioids. An effect of long lasting stress on the gastroesophageal reflux disease is supposed, yet it was not confirmed by any clinical study.
Manifestations of Gastroesophageal Reflux Disease
The typical symptom of gastroesophageal reflux disease is heartburn, which is present in about 80% of patients. Heartburn occurs mostly after eating and when lying down or bending forward. Other symptom is regurgitation of the gastric juices to the mouth. Less often dysphagia, chest pain, increased salivation, belching or pain in the stomach area are present. Among symptoms outside esophagus are halitosis, cariosity, hoarseness, cough, recurrent pulmonary infections, and more. However, in some patients no symptoms are present. The disease without any symptoms is typical for older people that have reduced gastric juices acidity and pain perception. In this group, the disease becomes obvious first with its complications that occur in up to 20% of all the patients. Among these complications there are narrowing of the lumen of the esophagus, ulcers, bleeding, Barrett's esophagus (a condition that can lead even to cancer of the esophagus).
Complications of Gastroesophageal Reflux Disease
Gastroesophageal reflux disease is a disease that must be treated; otherwise complications can occur. As a result of the irritation of the lower esophagus by stomach acid, the area becomes inflamed, which is called reflux esophagitis. Prolonged inflammation can lead to esophageal stenosis, i.e. narrowing of the esophagus. Later, the food accumulates before this obstacle. In this terrain, duodenal ulcers may develop. Duodenal ulcer is a deep affection to the wall of the esophagus, which can lead to bleeding or perforation of the organ. Finally, there is a risk of change in the lower esophagus cells, called Barrett's esophagus. Barrett's esophagus may easily turn into rising of malignant tumour in the esophagus.
Diagnosis of Gastroesophageal Reflux Disease
For the diagnosis of gastroesophageal reflux disease, the endoscopic examination is crucial; sometimes even accompanied by tissue sampling. The examination is performed by a thin flexible tube, introduced to the body by a patient's mouth. The tube consists of a camera and light source; the inside of the esophagus is examined. If necessary, small samples of tissue can be collected for histological testing. Even if the mucous membrane seems normal, histological testing is the decisive examination. The smallest changes in the cells can be observed by this examination. Furthermore, the pH in the esophagus can be monitor in order to prove an increase in the acidity of the esophageal environment.
Treatment of Gastroesophageal Reflux Disease
Generally speaking, gastroesophageal reflux disease is a long-term disease that tends to reappear after treatment. The essential in gastroesophageal reflux treatment are regime measures; medicaments and even surgical intervention are also used, however.
Regime measures include weight reduction in obese patients and diet modification. The diet should comprise non-irritant food and alcohol abstinence. It is also recommended not to eat 2-3 hours before going to sleep.
Among the medicaments recommended in gastroesophageal reflux disease, the most efficient are medicaments that reduce the acidity of gastric juices. They must be administered for several weeks on empty stomach. So-called prokinetics that affect gastrointestinal motility are also very effective.
In some cases, it is possible to undergo a surgical treatment. The surgery technique is mostly laparoscopy these days; so that no big scar is left afterwards. The surgery consists of a cuff formed by the upper part of the stomach that circles around the lower part of the esophagus, it is called anti-reflux plastic. The success rate of this operation is very high.