Marketing Scoops: Suffering With Acid Reflux? Here’s How To Fix It, From a Gastroenterologist

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You’ve just enjoyed a great meal, maybe with a few drinks. Suddenly your throat is on fire, there’s a bad taste in your mouth, and you’ve got heartburn. This is known as acid reflux, and is one of the most commonly diagnosed digestive disorders in the U.S.

Everyone experiences acid reflux every now and again, but if it is a regular occurrence it can have a significant effect on daily life, and could be a sign of gastroesophageal reflux disease (GERD).. …Continue reading…

By: Leonie Helm

Source: Marketing Scoops: Suffering With Acid Reflux? Here’s How To Fix It, From a Gastroenterologist

Critics:

The most common symptoms of GERD in adults are an acidic taste in the mouth, regurgitation, and heartburn. Less common symptoms include pain with swallowing/sore throat, increased salivation (also known as water brash), nausea, chest pain, coughing, and globus sensation. The acid reflux can induce asthma attack symptoms like shortness of breath, cough, and wheezing in those with underlying asthma.

GERD sometimes causes injury to the esophagus. These injuries may include one or more of the following:

Reflux esophagitis – inflammation of esophageal epithelium which can cause ulcers near the junction of the stomach and esophagus^[19]
Esophageal strictures – the persistent narrowing of the esophagus caused by reflux-induced inflammation
Barrett’s esophagus – intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus^[20]
Esophageal adenocarcinoma – a form of cancer

GERD sometimes causes injury of the larynx (LPR). Other complications can include aspiration pneumonia. GERD may be difficult to detect in infants and children since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing.

Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD.

Of the estimated 4 million babies born in the US each year, up to 35% of them may have difficulties with reflux in the first few months of their lives, known as ‘spitting up’. About 90% of infants will outgrow their reflux by their first birthday. Acid reflux into the mouth can cause breakdown of the enamel, especially on the inside surface of the teeth.

A dry mouth, acid or burning sensation in the mouth, bad breath and redness of the palate may occur. Less common symptoms of GERD include difficulty in swallowing, water brash, chronic cough, hoarse voice, nausea and vomiting. Signs of enamel erosion are the appearance of a smooth, silky-glazed, sometimes dull, enamel surface with the absence of perikymata, together with intact enamel along the gum margin.

It will be evident in people with restorations as tooth structure typically dissolves much faster than the restorative material, causing it to seem as if it “stands above” the surrounding tooth structure. GERD may lead to Barrett’s esophagus, a type of intestinal metaplasia, which is in turn a precursor condition for esophageal cancer. The risk of progression from Barrett’s to dysplasia is uncertain, but is estimated at 20% of cases.

Due to the risk of chronic heartburn progressing to Barrett’s, EGD every five years is recommended for people with chronic heartburn, or who take drugs for chronic GERD. A small amount of acid reflux is typical even in healthy people (as with infrequent and minor heartburn), but gastroesophageal reflux becomes gastroesophageal reflux disease when signs and symptoms develop into a recurrent problem.

Frequent acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the stomach and the esophagus.

Factors that can contribute to GERD:

Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors.
Obesity: increasing body mass index is associated with more severe GERD. In a large series of 2,000 patients with symptomatic reflux disease, it has been shown that 13% of changes in esophageal acid exposure is attributable to changes in body mass index.

Factors that have been linked with GERD, but not conclusively:

Obstructive sleep apnea
Gallstones, which can impede the flow of bile into the duodenum, which can affect the ability to neutralize gastric acid

In 1999, a review of existing studies found that, on average, 40% of GERD patients also had H. pylori infection. The eradication of H. pylori can lead to an increase in acid secretion, leading to the question of whether H. pylori-infected GERD patients are any different from non-infected GERD patients.

A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.The diagnosis of GERD is usually made when typical symptoms are present. Reflux can be present in people without symptoms and the diagnosis requires both symptoms or complications and reflux of stomach content. Other investigations may include esophagogastroduodenoscopy (EGD).

Barium swallow X-rays should not be used for diagnosis. Esophageal manometry is not recommended for use in the diagnosis, being recommended only prior to surgery. Ambulatory esophageal pH monitoring may be useful in those who do not improve after PPIs and is not needed in those in whom Barrett’s esophagus is seen. Investigation for H. pylori is not usually needed.

The current gold standard for diagnosis of GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and allows monitoring GERD patients in their response to medical or surgical treatment. One practice for diagnosis of GERD is a short-term treatment with proton-pump inhibitors, with improvement in symptoms suggesting a positive diagnosis.

Short-term treatment with proton-pump inhibitors may help predict abnormal 24-hour pH monitoring results among patients with symptoms suggestive of GERD. Endoscopy, the examination of the stomach with a fibre-optic scope, is not routinely needed if the case is typical and responds to treatment.It is recommended when people either do not respond well to treatment or have alarm symptoms, including dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes.

Some physicians advocate either once-in-a-lifetime or 5- to 10-yearly endoscopy for people with longstanding GERD, to evaluate the possible presence of dysplasia or Barrett’s esophagus. Biopsies performed during gastroscopy may show:

Edema and basal hyperplasia (nonspecific inflammatory changes)
Lymphocytic inflammation (nonspecific)
Neutrophilic inflammation (usually due to reflux or Helicobacter gastritis)
Eosinophilic inflammation (usually due to reflux): The presence of intraepithelial eosinophils may suggest a diagnosis of eosinophilic esophagitis (EE) if eosinophils are present in high enough numbers. Less than 20 eosinophils per high-power microscopic field in the distal esophagus, in the presence of other histologic features of GERD, is more consistent with GERD than EE.
Goblet cell intestinal metaplasia or Barrett’s esophagus
Elongation of the papillae
Thinning of the squamous cell layer
Dysplasia
Carcinoma