Wednesday, March 07, 2007

Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease is an injury to the esophagus that develops from chronic exposure of the esophagus to acid coming up from the stomach (reflux). In contrast, heartburn is the symptom of acid in the esophagus, characterized by a burning discomfort behind the breastbone (sternum). Findings in GERD include esophagitis (reflux esophagitis) - inflammatory changes in the esophageal lining (mucosa), strictures, difficulty swallowing (dysphagia) and chronic chest pain. Patients may have only one of those findings. Atypical symptoms of GERD include cough, hoarseness, changes of the voice, and sinusitis. Complicatons of GERD include stricture formation, Barrett's esophagus, esophageal ulcers and possibly even to esophageal cancer.
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.

Avoiding aggravating factors
Lifestyle modifications is the term physicians use when recommending non-pharmaceutical treatments for GERD.

Certain foods and lifestyle tend to promote gastroesophageal reflux:

Coffee, alcohol, calcium supplements, and excessive amounts of Vitamin C supplements are stimulants of gastric acid secretion so avoiding these helps. Calcium containing antacids such as TUMS (Calcium carbonate) are in this group[1]
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
elevate the head of the bed on 6 inch blocks. (Pillows under the head and shoulders have been shown to be ineffective.)
avoid sodas that contain caffeine
avoid chocolate and peppermint
avoid spicy foods
avoid acidic foods like oranges and tomatoes
avoid cruciferous vegetables: onions, cabbage, cauliflower, broccoli, Brussel sprouts
avoid fried and fatty foods
avoid milk and heavily milk based products
Avoiding food for 2 hours before bedtime, as well as not lying down after a meal, are the most important of the lifestyle modifications. Elevation to the head of the bed is the next easiest to implement. If pharmacologic therapy in combination with food avoidance before bedtime and elevation of the head of the bed, then the other steps are recommended.

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