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What is gastric reflux? – Its symptoms, causes and treatment

Sickness Gastroesophageal reflux (GORD: Gastro-oesophageal reflux disease) or for short stomach reflex A common condition in which acid travels from the stomach into the esophagus and then into the throat, usually as a result of weakening of the lower esophageal sphincter. Gastric reflux symptoms like heartburn Or heartburn And it brings an unpleasant taste at the end of the mouth. Although this disease may be an occasional nuisance for some, it can be considered a severe and lifelong problem for others.

Gastric reflux can often be controlled with self-help measures and medication. Sometimes surgery may be needed.

What are the symptoms of gastric reflux?

The main symptom of gastroesophageal reflux disease is heartburn and acid reflux.

Heartburn is an uncomfortable burning sensation in the chest area that is usually felt just below the breastbone, but some people also feel it up to their throat.

This condition usually worsens after eating or when bending and lying down.

Acid reflux is the return of acid and other stomach contents to the throat and mouth, which usually causes an unpleasant and sour taste at the end of the mouth.

  • Esophagitis (wounded and inflamed esophagus)
  • Bad Breath
  • Bloating and sore throat
  • Feel sick
  • Difficulty swallowing: You may feel that a piece of food is stuck in your throat.
  • Pain when swallowing
  • Sore throat and hoarseness
  • Persistent coughing or wheezing, which may worsen at night.
  • Tooth decay and gum disease
  • Irritation of airways in patients with asthma

What are the causes of stomach reflux?

Gastric reflux is usually caused by a weakening of the lower esophageal sphincter.

Normally, this loop of muscle opens to allow food to enter the stomach and then closes to prevent stomach acid from leaking into the esophagus. However, in people with acid reflux, acid backs up into the esophagus and causes heartburn and other symptoms.

It’s not known exactly what causes this muscle ring to weaken, but certain things can increase the risk of it happening.

Closing the valve connecting the esophagus to the stomach prevents the leakage of stomach acid into the esophagus.

Who is more prone to gastric reflux?

The following factors may increase the risk:

  • Obesity: Being overweight puts more pressure on the stomach and weakens the muscles at the end of the esophagus.
  • Consuming a lot of fatty foods: Since the stomach needs more time to digest a fatty meal in order to eliminate the acid, the resulting excess acid may enter the esophagus.
  • Cigarettes, alcohol, coffee or chocolate: These may weaken the muscles at the end of the esophagus.
  • Pregnancy: temporary changes in the level of hormones and increased pressure on the stomach during pregnancy may also cause this disease.
  • Hiatal hernia: Occurs when part of the stomach pushes through the diaphragm towards the chest.
Comparison of healthy stomach (left) and with hiatal hernia (right).
  • Gastroparesis or stomach paralysisIn this condition, it takes longer for the stomach to rid itself of acid, which means that excess acid can leak into the esophagus.
  • Medicines: Some medicines can cause gastric reflux or aggravate its symptoms: Calcium channel blockers (Treatment of high blood pressure), nitrates (Treatment angina pectoris Or Cardiac angina) And Non-steroidal anti-inflammatory drugs (Treatment of inflammation and pain).
  • Heredity: Sometimes several members of a family are involved in this disease. The results of studies indicate that genetics play a significant role (31%) in the probability of contracting this disease.

Diagnosis of gastric reflux

A doctor usually diagnoses a disease based on symptoms and may prescribe medication to treat it without the need for any tests.

When is a test needed for diagnosis?

They usually only recommend testing if:

  • The doctor is not sure about the patient’s symptoms.
  • Symptoms are persistent, severe, or unusual.
  • Prescription drugs are not able to control the symptoms.
  • The general practitioner recommends surgery.
  • Symptoms of a potentially more serious illness include difficulty swallowing or unwanted weight loss.

What tests are prescribed to diagnose gastric reflux?

The patient may have one or more of the following tests:

Endoscopy is a procedure in which the inside of the body is examined using an endoscope (a long, thin, flexible tube with a light and a camera at the end).

The endoscope is slowly inserted into the mouth and back of the throat. The procedure is usually performed while awake, but usually with preoperative sedation.

The images obtained from the endoscope show the possible damages of the surface of the esophagus, caused by stomach acid. Although this complication is not evident among all sufferers.

This test is used to evaluate the ability to swallow and check for any obstruction or abnormality in the esophagus.

First, the patient drinks a barium solution, then x-ray images are taken. Barium is a harmless substance whose passage through the digestive tract is clearly visible on X-rays.

The patient should not eat anything for a few hours before the test. After it is done, eating and drinking is unimpeded and the patient is advised to drink plenty of fluids to eliminate barium.

X-ray images taken after drinking barium.

Manometry is used to evaluate the function of the muscle ring at the end of the esophagus by measuring the pressure in the esophagus.

For this purpose, a small tube is passed through the nose and then directed to the esophagus. This tube contains pressure sensors that can detect pressure in the esophagus.

With the help of manometry, doctors can rule out other possible causes of symptoms and evaluate the necessity of surgery.

The manometry catheter is inserted into the stomach through the nose.
  • 24 hour pH monitoring

If the endoscopy shows no specific symptoms, they may measure the acidity (pH) level of the esophagus to confirm the diagnosis.

A thin tube containing a sensor that passes through the nose and esophagus measures acidity levels over the course of a day and night. This tube is usually connected to a recording device that is worn around the patient’s waist.

Every time the patient is aware of his symptoms, he presses a button on the device and records his symptoms in a book. In addition, to ensure an accurate result, the patient should eat as normal during the test.

In the 24-hour acidity level monitoring, the patient reports the occurrence of symptoms by pressing a button on the device and records them.

Blood tests may sometimes be recommended to check for anemia, which can be a sign of internal bleeding.

What to do in case of stomach reflux?

Gastric reflux can be controlled to a great extent by making some changes in lifestyle and taking medicine.

If you only have occasional acid reflux symptoms, you don’t necessarily need to see a doctor and you can consult a pharmacist.

When should you see a doctor?

If you are worried about your condition or if you have the following symptoms, it is better to consult a doctor:

  • Symptoms occur several times a week.
  • Over-the-counter medications do not help.
  • severe symptoms; Such as persistent vomiting, vomiting blood, or unwanted weight loss.
  • Have trouble swallowing.

Treatment of gastric reflux

Reflux symptoms can often be controlled by making lifestyle changes or taking over-the-counter medications. Prescription medication may only be needed when experiencing more severe symptoms, although long-term treatment may be unavoidable if the problem persists.

Some cases in the treatment of gastric reflux include:

  • Self-help measures: eating smaller but frequent meals, avoiding any drinks or foods that aggravate symptoms, elevating the head of the bed and maintaining a healthy weight, avoiding alcohol, coffee, chocolate, tomatoes, and fatty or spicy foods.
  • Avoiding tight clothing: Clothing that is tight around the abdomen may worsen symptoms.
  • Stay calm: Stress can make heartburn and acid reflux worse, so if you often feel anxious, learning relaxation techniques can help.
  • Staying fit: If you are overweight, losing weight will help moderate your symptoms.
  • Smoking cessation: Cigarette smoke irritates the digestive system and aggravates the symptoms.
  • Over-the-counter medications: You can get an antacid or alginate from a pharmacy.
  • Stronger prescription drugs: such as proton pump inhibitors and receptor antagonists.
Methods to prevent gastroesophageal reflux disease.

Treatment of gastric reflux with drugs

A number of prescription and non-prescription drugs are used in the treatment of this disease:

Non-prescription drugs

Many heartburn and gastroesophageal reflux medications are available over-the-counter and over the counter, the main ones being:

  • Antacids: neutralize the effects of stomach acid.
  • Alginates: produce a protective coating for the stomach and esophagus against stomach acid.
  • Low-dose proton pump inhibitors and H2-receptor antagonists: reduce the amount of acid produced by the stomach.

Treatment of gastric reflux with surgery

Surgery is considered a treatment option if:

  • The above treatments do not help, are not suitable for the patient or cause troublesome side effects.
  • The patient does not want to take medicine in the long term.
Types of surgery

The main method used is laparoscopic fundoplication (Laparoscopic Nissen Fundoplication: LNF). Alternative techniques have recently been developed, although they are not yet widely available.

  • Laparoscopic fundoplication: This surgery is called laparoscopic or keyhole; It means that it is done using special surgical tools that enter the skin through small incisions. This method is used to tighten the muscle ring of the lower esophagus. After laparoscopy, most patients are hospitalized 2 or 3 days after the operation, and the recovery period will be between 3 and 6 weeks. For the first 6 weeks after surgery, the patient should only eat soft foods such as mashed potatoes or soup. Some may experience swallowing problems, wind and bloating after this surgery, but they will get better with time.
Stomach status before, during and after laparoscopic fundoplication surgery.

According to the US National Institutes of Health, these methods seem to involve less risk, but not much is known about their long-term effects:

  • Endoscopic injection of bulky materials: a special filler is injected into the middle area of ​​the stomach and esophagus to make it narrower.
  • Gastric plication (gastric suture): is an endoluminal procedure in which a series of sutures are placed just below the valve between the esophagus and the stomach to create folds to reduce the amount of reflux.
  • Endoscopic augmentation with hydrogel implants: implants containing a special gel are placed in the wall of the valve between the stomach and esophagus to make it narrower.
Performance of endoscopic augmentation with hydrogel implants to narrow the gastroesophageal valve and reduce gastric reflux.
  • Radiofrequency ablation: A small balloon is moved down the esophagus and electrodes attached to it are used to heat and narrow the esophagus.
Radiofrequency energy transfer to the gastroesophageal junction for the treatment of gastric reflux.
  • Laparoscopic magnetic band placement: A ring of magnetic beads is implanted around the lower part of the esophagus to strengthen it and help keep the area closed during swallowing.
A ring of magnetic beads controls the size of the esophagus.

Complications Gastroesophageal reflux

If you’ve had acid reflux for a long time, stomach acid can damage your esophagus and cause more problems:

  • Ulcers on the esophagus: the esophagus may bleed and make swallowing painful.
  • Narrow esophagus: can make swallowing difficult and may require surgery to improve.
  • Barrett’s esophagus: Changes in the cells lining the lower esophagus that sometimes lead to esophageal cancer.
  • Esophageal cancer: Studies have shown that 1 out of 10 to 20 people with Barrett’s esophagus will develop esophageal cancer within 10 to 20 years.
Some symptoms of stomach cancer include difficulty swallowing, unwanted weight loss, persistent indigestion, hoarseness, persistent cough or coughing up blood, vomiting.

Abstract

Gastroesophageal reflux disease occurs when stomach contents return to the esophagus.

The symptoms of this disease at any age can be annoying and if not controlled, it can even lead to long-term damage to parts of the digestive system. But the good news is that these symptoms can usually be managed by modifying some daily habits.

If these changes do not completely improve the patient’s symptoms, the doctor prescribes medication to reduce acid reflux or, in a surgery, strengthens and repairs the muscular ring of the esophagus to the stomach.

common questions

Why do we suddenly have gastroesophageal reflux disease?

This can happen for a number of reasons that cause an abnormal increase in intra-abdominal pressure, including being overweight or obese, overeating frequently, lying down too soon after eating, straining or coughing for a long time, lifting heavy objects. in long term.

Is gastroesophageal reflux disease dangerous?

Although chest pain is often a symptom of acid reflux, if it becomes more serious (regular and severe vomiting), it is important to see a doctor immediately. Sometimes the symptoms of gastroesophageal reflux disease require immediate attention.

What is the difference between acid reflux and gastroesophageal reflux disease?

Acid reflux is the return of stomach contents to the esophagus. Acid reflux is accompanied by heartburn: a mild burning sensation in the middle of the chest, often after eating or when lying down. Gastroesophageal reflux disease is a more serious form of acid reflux.

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