Current Trends in the Management of Gastroesophageal Reflux Disease: A Review

What are the symptoms of acid reflux?

affect different individuals or even in the same individual at different times. A small number of patients with GERD produce abnormally large amounts of acid, but this is uncommon and not a contributing factor in the vast majority of patients. It has also been found that liquid refluxes to a higher level in the esophagus in patients with GERD than normal individuals.

Pro-motility drugs work by stimulating the muscles of the gastrointestinal tract, including the esophagus, stomach, small intestine, and/or colon. One pro-motility drug, metoclopramide (Reglan), is approved for GERD. Pro-motility drugs increase the pressure in the lower esophageal sphincter and strengthen the contractions (peristalsis) of the esophagus. Both effects would be expected to reduce reflux of acid.

Over time, the scar tissue shrinks and narrows the lumen (inner cavity) of the esophagus. This scarred narrowing is called a stricture. Swallowed food may get stuck in the esophagus once the narrowing becomes severe enough (usually when it restricts the esophageal lumen to a diameter of one centimeter).

Only occasionally is it necessary to re-operate to revise the prior surgery. The drugs described above usually are effective in treating the symptoms and complications of GERD.

Otherwise, take this quiet time for yourself and remember to breathe. Surgery is another option if drugs don’t help or if you want to avoid potential side effects. Your surgeon can perform LINX surgery to strengthen the esophageal sphincter using a device made from magnetic titanium beads. Nissen fundoplication is another surgery they can perform to reinforce the esophageal sphincter. This involves wrapping the top of the stomach around the lower esophagus.

Other nerves that are stimulated do not produce pain. Instead, they stimulate yet other nerves that provoke coughing. In this way, refluxed liquid can cause coughing without ever reaching the throat! In a similar manner, reflux into the lower esophagus can stimulate esophageal nerves that connect to and can stimulate nerves going to the lungs. These nerves to the lungs then can cause the smaller breathing tubes to narrow, resulting in an attack of asthma.

If the esophagus is normal and no other diseases are found, the goal of treatment simply is to relieve symptoms. Therefore, prescription strength H2 antagonists or PPIs are appropriate. If damage to the esophagus (esophagitis or ulceration) is found, the goal of treatment is healing the damage.

Acid Reflux

Calcium-based antacids (usually calcium carbonate), unlike other antacids, stimulate the release of gastrin from the stomach and duodenum. Gastrin is the hormone that is primarily responsible for the stimulation of acid secretion by the stomach. Therefore, the secretion of acid rebounds after the direct acid-neutralizing effect of the calcium carbonate is exhausted. The rebound is due to the release of gastrin, which results in an overproduction of acid. Theoretically at least, this increased acid is not good for GERD.

Nevertheless, it is still debated whether a finding of reduced gastric emptying should prompt changes in the surgical treatment of GERD. Gastric emptying studies are studies that determine how well food empties from the stomach.

The esophagus may also be referred to as the food pipe or gullet and is the tube that transports food from the mouth to the stomach. GERD may result from a dysfunctional valve at the top of the stomach and bottom of the esophagus.

Endoscopy allows the doctor to see the esophagus and stomach lining through a thin tube with a lighted camera at its end that is inserted down the esophagus. During endoscopy, a small tissue sample can be removed for analysis and damage to the esophageal lining can be evaluated. Most people describe heartburn as a painful burning sensation in the chest, sometimes along with a sour taste in the mouth and throat. When neutralized by an antacid, the burning sensation goes away.

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