Gastroesophageal Reflux Disease Causes and Treatment

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults.

People with asthma are at higher risk of developing GERD.

Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back, or reflux, into the esophagus. Some asthma medications (especially theophylline) may worsen reflux symptoms.
On the other hand, acid reflux can make asthma symptoms worse by irritating the airways and lungs. This, in turn, can lead to progressively more serious asthma.

Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke or cold air.

Symptoms and Signs

  • Reflux Esophagitis
  • Reflux Esophagitis
  • Photographs
  • Esophageal Stricture
  • Esophageal Stricture
  • Photographs
  • Barrett Esophagus
  • Barrett Esophagus

The most prominent symptom of GERD is heartburn, with or without regurgitation of gastric contents into the mouth. Infants present with vomiting, irritability, anorexia, and sometimes symptoms of chronic aspiration.

Both adults and infants with chronic aspiration may have cough, hoarseness, or wheezing.

Esophagitis may cause odynophagia and even esophageal hemorrhage, which is usually occult but can be massive. Peptic stricture causes a gradually progressive dysphagia for solid foods.

Peptic esophageal ulcers cause the same type of pain as gastric or duodenal ulcers, but the pain is usually localized to the xiphoid or high substernal region. Peptic esophageal ulcers heal slowly, tend to recur, and usually leave a stricture on healing.

Diagnosis

Clinical diagnosis

  • Endoscopy for patients not responding to empiric treatment
  • 24-h pH testing for patients with typical symptoms but normal endoscopy
  • A detailed history points to the diagnosis. Patients with typical symptoms of GERD may be given a trial of therapy. Patients who do not improve, or have long-standing symptoms or symptoms of complications, should be studied.

Endoscopy, with cytologic washings and biopsy of abnormal areas, is the test of choice. Endoscopic biopsy is the only test that consistently detects the columnar mucosal changes of Barrett esophagus.

Patients with unremarkable endoscopy findings who have typical symptoms despite treatment with proton pump inhibitors should undergo 24-h pH testing (see Ambulatory pH Monitoring).

Although barium swallow readily shows esophageal ulcers and peptic strictures, it is less useful for mild to moderate reflux; in addition, most patients with abnormalities require subsequent endoscopy. Esophageal manometry may be used to guide pH probe placement and to evaluate esophageal peristalsis before surgical treatment.

Treatment & Management

If you have both GERD and asthma, managing your GERD will help control your asthma symptoms.

Studies have shown that people with asthma and GERD saw a decrease in asthma symptoms (and asthma medication use) after treating their reflux disease.

Lifestyle changes to treat GERD include:

• Elevate the head of the bed 6-8 inches
• Lose weight
• Stop smoking
• Decrease alcohol intake
• Limit meal size and avoid heavy evening meals
• Do not lie down within two to three hours of eating
• Decrease caffeine intake
• Avoid theophylline (if possible)

Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and H2 blockers may help decrease the effects of stomach acid. Proton pump inhibitors block acid production and also may be effective.

In severe and medication intolerant cases, surgery may be recommended.

Key Points

Lower esophageal sphincter incompetence allows gastric contents to reflux into the esophagus and sometimes into the larynx or lungs.

Complications include esophagitis, peptic esophageal ulcer, esophageal stricture, Barrett esophagus, and esophageal adenocarcinoma.

The main symptom in adults is heartburn, and infants present with vomiting, irritability, anorexia, and sometimes symptoms of chronic aspiration; at any age, chronic aspiration may cause cough, hoarseness, or wheezing.

Diagnose clinically; do endoscopy in patients not responding to empiric treatment and 24-h pH monitoring if endoscopy is normal in patients with typical symptoms.

Treat with lifestyle changes (eg, head of bed elevation, weight loss, dietary trigger avoidance) and a proton pump inhibitor.

Antireflux surgery can help patients with complications or a large amount of symptomatic nonacid reflux.

Source & More Info: American Academy of Allergy Asthma and Immunology and Merck Manuals

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