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How does life feel when you are at a all-you-can eat buffet with your friends on a Saturday night? Those juicy burgers 🍔, crispy fries 🍟, cheesy pizzas 🍕 and not to forget the drinks 🍹. Uhh, life's perfect. Right? But what's worse than waking up next morning with a heartburn and acid reflux that gives you nightmares from yesterday. Uhh, why can't life be perfect??
What is GER or GERD and why should you care?
This condition where food from the stomach refluxes back into the esophagus, in a retrograde fashion, is known as gastroesophageal reflux or GER, commonly known as heartburn or acid reflux. Gastroesophageal Reflux Disease or GERD is a more severe, frequently repeated, long-lasting disease which leads to complications like Barrett's Esophagus and Esophagitis.
GERD is one of the most commonly diagnosed GI condition with documented prevalence up to about 20% in the West. Females are commonly more affected than males while males have a higher chance of developing chronic symptoms as compared to females.
Pathophysiology and are you at risk?
So basically, the stomach is lined by simple columnar epithelium along with numerous tubular glands that function to secrete gastric acid while the esophagus is lined by stratified squamous epithelium. The junction where the esophagus meets the stomach is called the "Z line" and wrapping around this we have muscular ring called as "lower esophageal sphincter/LES" which tightens/relaxes the junction to allow passage of food into the stomach as needed.
The main reason that causes GERD can't be confined to one factor instead GERD is more of a multifactorial condition. Some conditions that predispose individuals to GERD include obesity, presence of hiatal hernia, impaired LES function, decreased esophageal mucosal defence against acidity, certain medications, and pregnancy. Diet and lifestyle plays an important role in GERD mechanism. Foods rich in fat content, chocolate, coffee, alcohol and cigarettes tend to cause GER.
Presentation and what should you look out for?
Most affected individuals with GER typically present with retrosternal heartburn and acid regurgitation which leaves bitter/sour taste in the oropharynx which may deteriorate with eating. Other non common symptoms include difficulty swallowing (dysphagia), pain while swallowing (odynophagia). Non GI symptoms/Atypical symptoms may include chest pain (noncardiac), chronic cough, dysphonia, dental erosions, shortness of breath, etc.
Management and what can you do to prevent it?
Treatment and management of GER is revolves around lifestyle modifications, medical and surgical therapies. Simple lifestyle modifications makes the mainstay therapy method for GER, this includes eating less fatty foods/carbonated drinks, eating smaller meals, decrease risk by exercise, managing weight and preventing obesity, eating healthy balanced diets, rich in fresh fruits, vegetables, avoiding late night dinners and maintaining a good sleep hygiene.
Medical therapy may be prescribed along with lifestyle modification in treating GERD and is usually indicated to patients who do not respond well with lifestyle modifications. These medications include proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, and esomeprazole and histamine receptor antagonists (H2RAs) such as famotidine and cimetidine, which may be available over the counter.
While some patients do not respond to medical therapies, surgical treatment is indicated which involves surgically manage GERD symptoms or presence of factors which cause GER, such as hiatal hernia.
References
Assessed and Endorsed by the MedReport Medical Review Board