Disease Gastro-Esophageal Reflux

Gastroesophageal reflux disease (GERD) is a disorder of the digestive tract involving the esophagus, the tube that carries food from the mouth to the stomach.

In GERD, acid and digestive enzymes of the stomach flow back into the esophagus, which is the retrograde flow of gastric juice referred to as "reflux". Inflamed gastric juices coat the esophagus causing heartburn and other symptoms. If GERD is not treated can permanently damage the esophagus.

A muscular ring called the "lower esophageal sphincter" separates the stomach and esophagus normally only opens when swallowed, allowing the entry of food into the stomach. During the rest time, the sphincter remains contracted to prevent food and stomach acid into the esophagus retreat.

In most people with GERD, the lower esophageal sphincter does not close tightly and remains relaxed between swallows, allowing the digestive juices from the esophagus and irritates the lining of the organ.

There are many factors that can weaken or relax the lower esophageal sphincter, including:

• Tobacco

• Alcohol

• Pregnancy

• obesity (by increasing the pressure inside the abdomen)

• Certain foods

• Many medications

• Hiatus hernia (sliding part of the stomach to the region above the diaphragm, the muscle that separates the chest from the abdomen)

Prolonged exposure to acid can cause the esophagus:

• to become inflamed

• decrease in size (be narrowed)

• develop an ulcer.

This acid exposure can lead to long-term disease called "Barrett's esophagus", which increases the risk of esophageal cancer.

Prevention

There are several measures that can be taken to prevent the symptoms of GERD. Some simple changes in lifestyle include:

• Elevation of the head of the bed at least 7.5 cm, if possible, be placed wooden blocks under the legs of the bed on the side of the head or use a foam wedge under the mattress of the compact's bedside, using simple additional pads may not provide relief

• Avoid foods that cause sphincter relaxation during digestion, including:

coffee

Chocolate

the fatty foods

fat milk

the mint or peppermint (Mentha piperita and Mentha spicata)

• Limit your intake of acidic foods that aggravate the irritation when regurgitated, including citrus and tomatoes

• Avoid carbonated beverages because the belching gas force the opening of the esophageal sphincter and promote reflux

• Eat smaller meals and more frequently

• Do not go to bed immediately after eating. Should not eat for three to four hours before bedtime

• If you smoke, stop doing

• Avoid drinking alcohol as this causes relaxation of the lower esophageal sphincter

• Lose weight if you are overweight, and obesity can hinder the maintenance of the esophageal sphincter closed

• Avoid wearing tight clothing; increased pressure in the abdomen can open the lower esophageal sphincter

• Using pills or chewing gum to produce saliva

People with GERD for more than five years should be tested to identify the presence of Barrett's esophagus. If this situation is encountered, it is advisable to carry out endoscopies at regular intervals, so that any cancerous changes may be identified and treated when the cancer is in its early stages.

Treatment

The treatment for most people with GERD includes lifestyle changes described in the previous section, as well as drug if necessary. If symptoms persist, surgical or endoscopic provide additional options.

Medicines

There are many drugs that can be used to treat GERD, including:

• proton pump inhibitors - The proton pump inhibitors disrupt the production of acid by the stomach and are very effective in relieving symptoms. These drugs block the production of acid more powerful than the H2 blockers, but take longer to start its effect.

• H2 blockers - These drugs, which include famotidine, cimetidine and ranitidine, cause stomach produces less acid. The dose of medicine to be taken depends on the severity of symptoms.

• Protective mucosal - These drugs coat, protect and soothe irritated esophageal lining, sucralfate is an example.

• Antacids free sale - These substances neutralize the acid buffer. The liquid forms of these drugs act most quickly, but the tablets are more comfortable. Antacids that contain magnesium can cause diarrhea and those that contain aluminum can cause constipation. The doctor may advise the patient to switch antacids to avoid these problems. These drugs results in symptomatic relief for short periods and do not heal inflammation of the esophagus.

• Medications that increase the motility - These medicines may help lower esophageal reflux, since they help to empty the stomach more rapidly and, therefore, reduce the time during which may occur reflux. However, they are not very effective by itself and are generally used in combination with other classes of drugs.

Surgery

Surgery is an option for people with GERD symptoms severe and difficult to control and may also be considered for people who have complications, such as asthma or pneumonia, or scar tissue in the esophagus. Some people do not want to take drugs for long periods can also opt for surgery.

The anti-reflux surgery can be performed using instruments guided by a camera (laparoscopic surgery), which requires smaller incisions than conventional surgery.

In a procedure called Nissen fundoplication, excess stomach tissue is wrapped around the esophagus and then sutured in position so as to increase pressure around the lower esophageal sphincter weakened. It appears to relieve symptoms almost as effective as gastric acid-blocking medicines subject to prescription. The success rates of surgery may be lower in people whose symptoms are not relieved by antacids. After surgery, some people experience unpleasant side effects and prolonged (such as difficulty swallowing, diarrhea and inability to burp - "burp" - or vomit to relieve bloating or nausea), but most people are very satisfied with the results .

Endoscopic treatments

Three new treatments have been developed to strengthen the lower esophageal sphincter using an endoscope:

• suturing (plication)

• heating (Stretta procedure)

• injection sphincter with a material that promotes an increase in volume (procedure Enteryx)

As these treatments have been developed recently, their success rates in the long term are still unknown and little is known about their potential complications.