Gastroesophageal Reflux Disease

by Isabel Alves, a gastroenterologist at Lifeclinic® - Health care and Head of Gastroenterology Department of the Hospital S. Francisco Xavier

The heartburn and regurgitation are some of the main symptoms of Gastroesophageal Reflux Disease (GERD). Although common, this disease is still poorly understood by the general population, therefore, often sees progress to more severe stages saddled with it implications that the quality of life.

A chronic disease
Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus in the absence of vomiting. As often in periods after meals can, for a number of constraints, is likely to cause symptoms and / or promote wall lesions of the esophagus or esophageal extra.

The increased prevalence of GERD in the developed world over the past 50 years is directly proportional to the increase in obesity and sedentary lifestyle of western populations. Although the causes are unknown the primary mechanism is the incompetence of the antireflux barrier, being the most important factors in the relaxation of the passage of the esophagus to the stomach by having a reduced pressure, for it tends to relax inappropriately or due to a change in the anatomy of this area, such as hiatus hernia [1].

The most common symptoms are heartburn and regurgitation. While heartburn is a burning or stinging sensation behind the breastbone that may radiate along the esophagus to the neck, regurgitation is the return to the mouth of the stomach contents of effortless vomiting. Sometimes patients report only bitter or sour taste in my mouth. The pain with the passage of food or difficulty in passage of food are two other symptoms that may be mentioned. Less frequent are chronic cough, asthma, hoarseness, chest pain, the sense of "ball" in the neck, pain in mouth and tongue. Chest pain can be confused with the pain of cardiac origin is very important to exclude this cause.

In patients with GERD the change of lifestyle is very important and it is estimated that 25% of people with symptoms may respond to these simple measures. It is important to elevate the head of the bed about 10-20cm, avoid bending particularly after meals, losing excess weight, avoid large meals rich in fat and do not wear tight clothing, not eating 2 hours before bedtime. Foods that should be carefully monitored are chocolate, peppermint, citrus (orange and lemon), tomatoes, carbonated beverages, alcohol, coffee and tobacco. There are some medications such as anti-inflammatory drugs and salicylates that are harmful.

The diagnostic procedure of choice is endoscopy to diagnose the presence or absence of hiatus hernia and whether or not damage the wall of the esophagus, commonly designated by Esophagitis, allowing the collection of small fragments of tissue from the esophagus to be examined under the microscope , called biopsies. In patients who really need to prove the existence of reflux there are other diagnostic methods, which are called functional studies of the esophagus among which is the pH-metry of the 24 that through a nasal tube and a 24-hour period, You can study the relationships between symptoms and reflux episodes, thus evaluating the acid exposure at different times of day and its contribution to the injury of the esophagus.

Treatment aims to relieve symptoms, heal the injuries of the esophagus and prevent the emergence of more serious complications that are particularly ulceration, stenosis (narrowing of the esophagus), bleeding and Barrett's esophagus which is the replacement of the lining of the wall itself esophagus by a coating type of stomach and intestine.

If untreated, reflux disease can also lead to more serious complications, including the most feared, albeit of low incidence, cancer of the esophagus. So in addition to general measures of treatment is achieved with drugs that inhibit gastric acid secretion (omeprazole, lansoprazole, pantoprazole) may be added prokinetic drugs that exert their action on motility of the esophagus and stomach (domperidone). All these drugs have excellent safety profiles in the short and long term. In cases of failure of medical treatment in selected patients and is currently a group of promising new technologies, the therapeutic endoscopic and laparoscopic surgery to try to reinforce the barrier Antireflux through various methods.

[1] What is hiatus hernia?
The diaphragm is a muscle that separates the organs that are housed in the chest organs that are located in the abdomen. The joint area between the esophagus and stomach, the lower esophageal sphincter is at the level of the diaphragm. The stomach is normally below the diaphragm, but sometimes a part of it passes through the diaphragm and is located in the chest. Is this part of the stomach that rises and becomes abnormal position called hiatus hernia. Often a hiatal hernia is associated with reflux disease.

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This article was published in BOA SAÚDE - O seu guia do bem estar No. 3 December.

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