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| ACID REFLUX DISEASE | |||||||||||||||||||||||||||||||||||||
| According to Jay W. Marks, the medical author of the section on acid reflux on the website medicinenet.com, "Gastroesophageal reflux disease, commonly referred to as GERD, or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up, or refluxes) into the esophagus. The esophagus is a muscular tube that extends from the lower throat to the stomach." The liquid that comes back up into the esophagus can destroy it, or at least the lining of it. It is a chronic condition and usually life long. If a person with GERD stops treatment, it will return, so treatment must be continual, and, in most cases, life long. | |||||||||||||||||||||||||||||||||||||
| ����������� Marks says, "The ways the body protects itself from the effects of reflux and acid are gravity, swallowing, and saliva. The problem is that they are only effective when a person is in the upright position. It is only really effective at night because you're lying down so gravity isn't in effect, swallowing stops because you're sleeping, and the extraction of saliva is reduced.� When reflux occurs at night, there is a high chance that the acid remains in the esophagus and causes for damage to it." | |||||||||||||||||||||||||||||||||||||
| ����������� P John Simic Director of Emergency Medicine at Providence/Saint Joseph Medical Center, and author of the section on acid reflux at emedicinehealth.com, says, "No one knows the exact cause of gastroesophageal reflux," though the causes of GERD are thought to be abnormally large amounts of acid, use of alcohol or cigarettes, obesity, poor posture (slouching), medications such as calcium channel blockers, theophyllincs (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates, and antihistamines. Other possible causes include diet, such as fatty foods, chocolate, drinks and caffeine, bad eating habits, and other medical conditions. According to Marks, "The parts of the body that contribute to this disease are the lower esophageal sphincter, hiatal hernias, esophageal contractions, and the emptying of the stomach." The lower esophageal sphincter (LES) is the most important part of the body that helps prevent reflux. "It is the muscle that makes up the lower-most end of the esophagus where it joins to the stomach," says Marks.� Two different abnormalities involve the LES. They are abnormally weak contractions and abnormal relaxations of the LES, which are called transient LES relaxations. The most recently-described one is laxity of the LES. | |||||||||||||||||||||||||||||||||||||
| ����������� "A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest," says Marks. It is a small hole in the diaphragm. The diaphragm is a muscular, horizontal partition that separates the chest from the abdomen. A small pouch of stomach above the diaphragm is a hernial sac which appears when a hiatal hernia is present.� The esophagus normally joins the stomach obliquely, but when it's not it does not prevent reflux which is when a hiatal hernia is present.� When a hiatal hernia is present, the entry of the esophagus is pulled up into the chest from the stomach. | |||||||||||||||||||||||||||||||||||||
| ����������� According to Marks, "Swallowing causes a ring-like wave of contraction of the esophageal muscles, which narrows the lumen (inner cavity) of the esophagus." Several abnormalities of contraction are waves of contraction and the pressure generated by the contractions. Smoking reduces the clearance of acid from the esophagus. As Marks observes, "The waves of contraction may die out before they reach the stomach. The pressure generated by the contractions may be too weak to push the acid back into the stomach." | |||||||||||||||||||||||||||||||||||||
| ����������� Symptoms of reflux are heartburn, dyspepsia, regurgitation, and nausea. Heartburn is a burning pain in the middle of the chest and can occur after a heavy meal, bending over, lifting, and lying down. The pain of heartburn can last for 2 hours. Dyspepsia is a syndrome involving pain and discomfort in the upper abdomen, fullness in the stomach and nausea after eating. Regurgitation is the refluxed liquid in the mouth. It's a feeling of acid backed up into the throat. Less severe symptoms of acid reflux are chest sensations or pain, throat problems, coughing and respiratory symptoms, and chronic nausea and vomiting. According to Harvey Simon, Associate Professor of Medicine at Harvard University Medical School, and editor of the section on Acid reflux at healthcentrral.com, "Chest sensations and pain is a sensation that food is trapped behind the breastbone." Symptoms of the throat include acid laryngitis, trouble swallowing (dysphagia), chronic sore throat, and persistent hiccups. Acid laryngitis is a condition that includes hoarseness, dry cough, the sensation of a lump in the throat, and the need to repeatedly clear the throat. In trouble swallowing, patients may choke or food may become trapped in the esophagus. Coughing and respiratory symptoms include asthmatic symptoms. Nausea is an uncommon symptom of acid reflux, but it may get severe enough and result in vomiting. | |||||||||||||||||||||||||||||||||||||
| ����������� According to Marks, "To confirm the diagnosis, physicians often treat patients with medications to suppress the production of acid by the stomach." This approach is commonly called therapeutic trial. Problems arise, however, because it doesn't include tests. Helicobacter pylori is a type of infection that can cause ulcers. It is a bacterium found in the mucous membranes. Upper gastrointestinal endoscopy is a common way of diagnosing acid reflux. Upper gastrointestinal endoscopy is performed when a tube is put down the throat sothat the lining of the esophagus, stomach, and duodenum can be examined. X-rays were used to diagnose acid reflux before endoscopies. In order to get an x-ray, a patient would have to swallow barium in order to get a clear picture. | |||||||||||||||||||||||||||||||||||||
| ����������� The main goal of treatment is to reduce the amount of acid in the stomach. A life-style change is one the simplest treatments for acid reflux. Several changes in eating habits are very helpful in treating acid reflux. Another treatment is chewing gum. Marks says, "Chewing gum stimulates the production of more bicarbonate-containing saliva and increases the rate of swallowing." Antacids neutralize the acid in the stomach. According to Simon, "There are two major treatment options are known as the step-up and the step-down approach." | |||||||||||||||||||||||||||||||||||||
| The step-up is when the patient first tries the H2-blocker drug. The step-down approach is when the patient first uses a more potent agent, such as prilosec. Surgery should be the last option of treatment. | |||||||||||||||||||||||||||||||||||||
| ����������� One type of drug, called proton pump inhibitors (PPI), has been developed specifically for acid-related diseases. Some PPI drugs are omeprazole (Prilosec), lansoprazole (Prevacid), rebeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). PPI's are best taken at least a half an hour to an hour before you eat. This is so because PPI's work best when the stomach is producing acid. The PPI's are not only good for treating the symptoms; they also protect the esophagus from the acid built up in the stomach. | |||||||||||||||||||||||||||||||||||||
| ����������� Living with the disease is okay at times, but if you ever forget to take your medicine, you can become very sick and will take a few days to recuperate. There are a lot of foods that you could eat before that you have to stop eating completely, like milk, ketchup and pizza. Cutting out greasy foods can lessen your acid reflux, but it will not make it go away. If treatment stops, it will eventually come back. This is a life-long disease, but there are ways to keep it from taking over your life. | |||||||||||||||||||||||||||||||||||||
| REFERENCES | |||||||||||||||||||||||||||||||||||||
| W. Marks, Jay. (June 6, 2003). Gastroesophageal Reflux Disease (GERD, Acid | |||||||||||||||||||||||||||||||||||||
| Reflux). Retrieved November 5, 2007 from http://www.medicinenet.com/gastroesohageal_reflux_disease_gerd/article.htm. | |||||||||||||||||||||||||||||||||||||
| Simic. John. (August 10, 2005). Reflux Disease (GERD). Retrieved November | |||||||||||||||||||||||||||||||||||||
| ����������� 5, 2007 from http://www.emedicinehealth.com/reflux_disease_gerd/page | |||||||||||||||||||||||||||||||||||||
| 18_em.htm. | |||||||||||||||||||||||||||||||||||||
| Simon, Harvey. (June 6, 2006). More Acid Reflux (GERD) Symptoms. | |||||||||||||||||||||||||||||||||||||
| Retrieved �November 5, 2007 from http://www.healthcentral.com/acid-reflux/introduction-000085_12-145.html?ic=506019. | |||||||||||||||||||||||||||||||||||||
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