The most common signs of GERD are:
- Trouble swallowing dysphagia
- Sche with swallowing odynophagia
- Increased salivation aka water brash
- Chest pain
GERD on occasion causes injury of the esophagus. These injuries may include:
Reflux esophagitis necrosis of esophageal epithelium causing ulcers near the connection of the stomach and esophagus.
Esophageal strictures the pervasive 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 lateral esophagus.
Esophageal adenocarcinoma a rare form of cancer.
some number of other atypical signs are related with GERD, but there's good evidence for causation only when they're accompanied by esophageal injury. These signs are:
- degenerative cough
- Laryngitis hoarseness, throat clearing
- wearing away of dental enamel
- Dentine hypersensitivity
- dinusitis and damaged teeth
Some people proposed that signs like sinusitis, recurrent ear infections, and idiopathic pulmonary fibrosis are caused by GERD, but, a causative role hasn't been established.
GERD can be hard to detect in infants and kids, since they can not describe what they're feeling and indicators must be observed. signs may differ from common adult signs. GERD in kids may because repeated vomiting, effortless spitting up, coughing, and other respiratory problems like wheezing. Inconsolable crying, refusing food, crying for food , then pulling off the bottle or breast only to cry for it again, failing to get adequate weight, bad breath, and belching or burping are common. kids may have one indication or many, no single indication is common in all kids with GERD.
it's estimated that of the roughly four million babies born in the U.S. yearly, up to 35% of them may have difficulties with reflux in the 1st not many months of their life, called spitting up. One hypothesis for this is the "4th trimester theory" which notes that majority animals are born with important mobility, but humans are comparatively helpless at birth, and suggests that there may have once been a 4th trimester, but that kids started to be born earlier, evolutionarily, to accommodate the development of bigger heads and brains and let them to pass through the birth canal and this leaves them with partially undeveloped digestive systems.
Most kids will outgrow their reflux by their 1st birthday. but, a small but important number of them won't outgrow the condition. This is especially true where there's a family history of GERD present.
GERD may lead to Barrett's esophagus, a kind of intestinal metaplasia, which is in turn a precursor condition for carcinoma. The risk of progression from Barrett's to dysplasia is uncertain but is estimated at 20% of cases. caused by the risk of degenerative heartburn progressing to Barrett's, EGD every five years is suggested for patients with degenerative heartburn, or who take drugs for degenerative GERD.
Endoscopic image of peptic stricture, or narrowing of the esophagus near the connection with the stomach. This is a complication of degenerative gastroesophageal reflux illness and may be a because of dysphagia or difficulty swallowing.
X ray of the stomach and chest in a patient with a gastrostomy. Radiocontrast has been injected into the stomach and quickly seen migrating upwards through the complete esophagus. The patient had serious reflux esophagitis Los Angeles grade D.
A in depth historical knowledge is important for an correct diagnosis. Useful investigations may include ambulatory Esophageal pH Monitoring, barium swallow X rays, esophageal manometry, and Esophagogastroduodenoscopy EGD.
The current gold standard for diagnosis of GERD is esophageal pH monitoring. it's the most objective test to diagnose the reflux illness and it also lets to monitor GERD patients in regards of their answer to medical or surgical treatment. One practice for diagnosis of GERD is a short term treatment with proton pump inhibitors, with improvement in signs proposing a positive diagnosis. as indicated by a systematic review, short term treatment with proton pump inhibitors may help predict irregular 24-hr pH monitoring results among patients with signs suggestive of GERD. In this study, the positive likelihood percentage of a indicative answer detecting GERD ranged from 1.63 to 1.87, with sensitivity of 0.78 although particularity was only 0.54.
In general, an EGD is done when the patient either doesn't react well to treatment or has alarm signs as well as dysphagia, anemia, blood in the stool detected chemically , wheezing, weight loss, or voice changes. Some physicians advocate either once in a-lifetime or 5/10-yearly endoscopy for patients with longstanding GERD, to assess the possible presence of dysplasia or Barrett's esophagus, a precursor lesion for esophageal adenocarcinoma.
Esophagogastroduodenoscopy EGD a form of endoscopy involves insertion of a thin scope through the mouth and throat into the esophagus and stomach frequently while the patient is sedated to assess the interior surfaces of the esophagus, stomach, and duodenum.
Biopsies may be performed throughout gastroscopy and these may show:
Edema and basal hyperplasia non specific inflammatory changes
Lymphocytic inflammation non specific
Neutrophilic inflammation typically caused by reflux or Helicobacter gastritis
Eosinophilic inflammation typically caused by reflux.
The presence of intraepithelial eosinophils may propose 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 lateral esophagus, in the presence of other histologic features of GERD, is more consistent with GERD than EE.
Goblet cell intestinal metaplasia or Barretts esophagus
Elongation of the papillae
Thinning of the squamous cell layer
Dysplasia or pre cancer
Reflux changes can be non erosive in nature, leading to the entity "non erosive reflux disease".
GERD is instigated by a failure of the cardia. In healthy patients, the "Angle of His" the angle at which the esophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can because burning and inflammation of sensitive esophageal tissue.
Factors that can give to GERD:
Hiatal hernia, which increases the likelihood of GERD caused by mechanical and motility factors.
Obesity: rising body mass index is related with more serious GERD. In a big series of 2000 patients with indicative reflux illness, it was shown that 13 % of changes in esophageal acid contact is attributable to changes in body mass index.
Zollinger Ellison syndrome, which may be present with increased gastric acidity caused by gastrin production.
Hypercalcemia, which can increase gastrin production, leading to increased acidity.
Scleroderma and systemic sclerosis, which can feature esophageal dysmotility.
The use of medicines like prednisolone.
Visceroptosis or Glénard syndrome, in which the stomach has sunk in the stomach upsetting the motility and acid secretion of the stomach.
GERD was linked to a range of respiratory and laryngeal complaints like laryngitis, degenerative cough, pulmonary fibrosis, earache, and asthma, when not clinically obvious. These atypical manifestations of GERD is usually called laryngopharyngeal reflux or as extraesophageal reflux illness EERD
Factors that have been linked with GERD, but not conclusively:
Obstructive sleep apnea
Gallstones, which can obstruct the flow of bile into the Duodenum, which can influence the capability to neutralize gastric acid
In 1999, a review of present studies found that, on average, 40% of GERD patients also had H. Pylori infection. The eradication of H. Pylori can lead to a raise in acid secretion, leading to the question of if H. Pylori infected GERD patients are any different than non infected GERD patients.
A double blind study, stated in 2004, found no clinically important difference between these two types of patients about the subjective or objective measures of illness seriousness.
GERD is mainly preventable through changes in lifestyle, which are used as treatment see below.
Sleep on the left side, or with your upper body raised.
break is frequently found by raising the head of the bed, raising the upper body with pillows, or sleeping sitting up. The upper body must be raised, not just the head, pillows that only increase the head do little for heartburn and put strain on the neck. Sleeping on the left side also keeps gravity working for you, keeping your stomach below your esophagus.
Eat smaller meals.
Eating a big meal causes extra stomach acid production, so attacks may be minimized by eating smaller meals. it's also important to avoid eating shortly before bedtime.
Gaining some pounds increases your risk of heartburn. Exactly why is not clear, but the leading hypothesis is that more body fat puts more pressure on the stomach, which can because greatly acidic stomach contents to reflux to the lower esophageal sphincter. For the same reason, tight clothing around the stomach may also increase the risk of heartburn.
Avoid acidic and rich foods.
although less supported by evidence, a sufferer may gain from keeping away from foods that trigger their signs. These usually include acidic fruit or juices, fatty foods, coffee, tea, onions, peppermint, chocolate, particularly shortly before bedtime.
Three types of treatments exist for GERD. these are lifestyle mods, medications, and operation.
Certain foods and lifestyle are considered to advertise gastroesophageal reflux, but a 2006 review suggested that evidence for most nutritional interventions is anecdotal, only weight loss and elevating the head of the bed were supported by evidence. A successive randomized crossover study showed benefit by keeping away from eating two hours before bedtime.
The following may worsen the signs of GERD:
Antacids depending on calcium carbonate but not aluminium hydroxide were found to really increase the acidity of the stomach. but, all antacids reduced acidity in the lower esophagus, so the net effect on GERD signs may still be positive.
Smoking decreases lower esophageal sphincter competence, allowing acid to enter the esophagus.
Sleeping on the left side was shown to decrease nighttime reflux episodes in patients.
A meta analysis suggested that elevating the head of the bed is an efficient medical care, though this conclusion was only supported by nonrandomized studies. The head of the bed may be elevated by plastic or wooden bed risers that support bed posts or legs, a therapeutic bed wedge pillow, a wedge or an inflatable mattress lifter that fits in between mattress and box spring or a hospital bed with an elevate feature. The height of the elevation is important and must be at least six to eight inches 15 to 20 cm to be at least minimally efficient to prevent the backflow of gastric fluids. Some innerspring mattresses don't work well when inclined and may because back ache, some favor bubble mattresses. Some practitioners use higher degrees of incline than offered by the usually suggested six to eight inches 15 to 20 cm and assert greater success.
some drugs are accepted to treat GERD, and are among the most prescribed medication in Western countries.
Proton pump inhibitors like omeprazole, esomeprazole, pantoprazole, lansoprazole, and rabeprazole are the most efficient in decreasing gastric acid secretion. These drugs stop acid secretion at the supply of acid production, i.E., the proton pump.
Gastric H2 receptor blockers like ranitidine, famotidine and cimetidine can decrease gastric secretion of acid. These drugs are theoretically antihistamines. They relieve complaints in about 50% of all GERD patients. in comparison to placebo which also is related with indication improvement , they have a number required to treat NNT of eight eight.
Antacids before meals or symptomatically after signs begin can decrease gastric acidity increase pH.
Alginic acid Gaviscon may coat the mucosa also as increase pH and decrease reflux. A meta analysis of randomized controlled trials suggests alginic acid can be the most efficient of non prescription treatments with a NNT of four.
Prokinetics strengthen the lower esophageal sphincter LES and speed up gastric emptying. Cisapride, a member of this class, was withdrawn from the market for causing long QT syndrome. Reglan metoclopramide is a prokinetic with a better side effect profile.
Sucralfate Carafate is useful as an adjunct in helping to heal and prevent esophageal damage caused by GERD, but it must be taken some number of times daily and at least two two hours separately from meals and medications.
Mosapride citrate is a 5-HT4 receptor agonist used outside the United States mainly as a medical care for GERD and dyspepsia.
Baclofen is an agonist of GABAB receptor. also to its skeletal muscle relaxant properties, it also has been shown to decrease temporary lower esophageal sphincter relaxations at a amount of 10mg given four times daily. Reductions in esophageal relaxation clinically decrease episodes of reflux.
medical trials which compare GERD treatments head to head supply physicians with important info. Unfortunately most pharmaceutical company supported studies are conducted versus placebo and not an active control. but, the DIAMOND showed rough equivalence of effectiveness between a "step up" approach to medical care antacids, followed by histamine antagonists, followed by PPIs and a "step down" approach the reverse. The main endpoint of the study was treatment success after six months, and has been achieved for 70% of patients in "step down" versus 72% of patients in "step up."
The standard surgical treatment is the Nissen fundoplication. In this procedure the upper part of the stomach is wrapped around the lower esophageal sphincter LES to strengthen the sphincter and prevent acid reflux and to fix a hiatal hernia. The procedure is frequently done laparoscopically. When in comparison to medical management laparoscopic fundoplication had better results at one year. also, laparoscopic fundoplication may decrease SF-36 score life quality questionnaire among patients with gastro esophageal reflux illness as in comparison to medical management as indicated by a Cochrane systematic review of randomized controlled trials. There were statistically important enhancements in life quality at three months and one year after operation in comparison to medical medical care, with an SF-36 general health score mean difference of -6.23 in favor of operation 95%CI = -7.83 to -7.82.
An out of date treatment is vagotomy "highly selective vagotomy" , the surgical elimination of vagus nerve branches that innervate the stomach lining. This treatment was mainly replaced by medication.
Another treatment is transoral incisionless fundoplication TIF with the use of a device called Esophyx, which lets doctors to rebuild the valve between the stomach and the esophagus by going through the esophagus.
In 2000 the U.S. Food and Drug governance FDA accepted two endoscopic devices to treat degenerative heartburn. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. but, long term results disappointed, and the device is not sold by Bard. Another, the Stretta Procedure, uses electrodes to apply radio frequency energy to the LES. The long term outcomes of both procedures in comparison to a Nissen fundoplication are being determined.
Subsequently the NDO Surgical Plicator has been cleared by the FDA for endoscopic GERD treatment. The Plicator creates a plication, or fold, of tissue near the gastroesophageal connection, and fixates the plication with a suture based implant. The company finished functionings in mid 2008, and the device is not on the market.
In pregnancy nutritional mods and lifestyle changes can be attempted but frequently have little effect. Calcium based antacids are suggested if these changes aren't efficient. Aluminum and magnesium antacids are safe as is ranitidine.
Treatment in Children
Kids may see break with changes in feeding methods, like smaller, more recurrent feedings, changes in position throughout feedings, or more recurrent burping throughout feedings.  They can also be treated with medicines like baby Zantac or Prevacid. sometimes both medicines can be prescribed simultaneously.