Gastroesophageal Reflux Disease Symptoms Adults GERD In Children

Occasional heartburn is common but does not necessarily mean one has GERD. Patients that have heartburn symptoms more than once a week are at risk of developing GERD. A hiatal hernia is usually asymptomatic, but the presence of a hiatal hernia is a risk factor for development of GERD.

1 Symptoms

1.1 Adults

The most prominent symptom of GERD is heartburn, the sensation of burning pain in the chest coming upward towards the mouth caused by reflux of acidic contents from the stomach to the esophagus.

Patients with GERD also tend to get the feeling of a sour or salty taste at the back of their throats due to regurgitation. This can sometimes happen even if the pain of heartburn is absent.

1.2 GERD in Children

GERD is commonly overlooked in infantThe word Infant derives from the Latin in-fans meaning unable to speak''. It is commonly used as a slightly more formal word for baby (the youngest category of child). A newborn baby is known as a neonate (neonatal after the final stage of gestation.s and childA child (plural: children) is a young human. Depending on context it may mean someone who is not yet an adult, or someone who has not yet reached puberty (someone who is prepubescent . When one refers to a person's children, one means their offspring i.ren. It can cause repeated vomitingVomiting (or emesis is the forceful expulsion through the mouth of the contents of one's stomach. It is a mechanism for expelling ingested illness-causing food poisons. The act may be triggered by stimuli which might indicate the possibility of poisoning,, coughing, and other respiratory problems.

2 Diagnosis

A detailed history taking is vital to the diagnosis. Useful investigations may include barium swallow X-rayIn the NATO phonetic alphabet, X-ray represents the letter X. Rontgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz to 60 EHz). X-rays, esophageal manometry, esophageal pHAlternate uses: see Ph pH (potential (of) hydrogen) is a measure of the concentration of hydrogen ions (H+) in a solution and, therefore, its acidity or alkalinity. The concept was introduced by S. Sorensen in 1909. The p stands for the German potenz mean monitoring and Esophagogastroduodenoscopy (EGD). In general, an EGD is done when the patient does not respond well to treatment, has had symptoms or required medications for a prolonged time (generally 5 years), has dysphagia, anemia, blood in the stool (detected chemically), has weight loss, or has changes in the voice.

3 Pathophysiology

Having GERD indicates incompetence of the lower esophageal sphincter . Increased acidity or production of gastric acid can contribute to the problem, as can obesity, tight fitting clothes and pregnancy. It is also thought that yeast infections of the digestive tract can cause GERD-like symptoms.

Factors that can contribute to GERD are:

Hiatus hernia increases the likelihood of GERD due to mechanical and motility factors.
Zollinger-Ellison syndrome can present with increased gastric acidity due to gastrin production.
Hypercalcemia can increase gastrin production, leading to increased acidity.
Scleroderma and systemic sclerosis can feature esophageal dysmotility.

4 Treatment

4.1 Avoiding aggravating factors

Certain foods and lifestyle tend to promote gastroesophageal reflux:

Coffee, alcohol, and calcium supplements are stimulants of gastric acid secretion so avoiding these helps.
Foods high in fats and smoking reduce lower esophageal sphincter competence so avoiding these tends to help as well.
Having more but smaller meals also reduces the risk of GERD as it means there is less in the stomach at any one time.

Advice generally given:

avoid eating for 2 hours before bedtime
avoid sodas that contain caffeine
avoid chocolate and peppermint
avoid spicy foods like pizza
avoid acidic foods like oranges and tomatoes
avoid fried and fatty foods

4.2 Drug treatment

A number of drugs is registered for the treatment of GERD, and they are amongst the most often prescribed forms of medication is most Western countries. They can be used in combination, although some antacids can impede the function of other medications:

Antacids before meals or symptomatically after symptoms begin can reduce gastric acidity (increase the pH).
Gastric H₂ receptor blockers such as ranitidine or famotidine can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all GERD patients.
Proton pump inhibitors such as omeprazole are even more effective in reducing gastric acid secretion.
Prokinetic s strengthen the LES and speed up gastric emptying. Cisapride, a member of this class, was withdrawn for causing Long QT syndrome.

4.3 Surgical treatment

The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done laparoscopically.

An obsolete treatment is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication.

4.4 Other treatments

In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. One system puts stitches in the LES to create little pleats that help strengthen the muscle. Another uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.

Recently, the FDA approved an implant that may help people with GERD who wish to avoid surgery. It is a solution that is injected during endoscopy and becomes spongy, reinforcing the LES to keep stomach acid from flowing into the esophagus. The implant is approved for people who have GERD and who require and respond to proton pump inhibitors. The long-term effects of the implant are unknown.

5 Barrett's esophagus

Barrett's esophagus, a type of dysplasia, is a precursor high grade dysplasia, which is in turn is a precursor condition for carcinoma. The risk of progression from Barretts to dysplasia is uncertain but is estimated to include 0.1 to 0.5% of cases, and has probably been exaggerated in the past. Due to the risk of chronic heartburn progressing to Barrett's, EGD every 5 years is recommended for patients with chronic heartburn, or who take medication for GERD chronically.

GERD has been linked to laryngitis, chronic cough , pulmonary fibrosis and asthma, even when not clinically apparent, as well as to ulcers of the vocal cords.

6 External links

Health science - Medicine - Gastroenterology

Diseases of the esophagus - stomach

Halitosis - Nausea - Vomiting - GERD - Achalasia - Esophageal cancer - Esophageal varices - Peptic ulcer - Abdominal pain - Stomach cancer - Functional dyspepsia

Diseases of the liver - pancreas - gallbladder - biliary tree

Hepatitis - Cirrhosis - NASH - Budd-Chiari syndrome - Hepatocellular carcinoma - Pancreatitis - Pancreatic cancer - Gallstones - Cholecystitis

Diseases of the small intestine

Peptic ulcer - Malabsorption (e.g. celiac disease, lactose intolerance, fructose malabsorption, Whipple's disease) - Lymphoma

Diseases of the colon

Diarrhea - Appendicitis - Diverticulitis - Diverticulosis - IBD ( Crohn's disease and Ulcerative colitis) - Irritable bowel syndrome - Constipation - Colorectal cancer - Hirschsprung's disease - Pseudomembranous colitis

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