Heartburn

Gastroesophageal reflux disease, commonly referred to as GERD, or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up, or refluxes) into the esophagus. The liquid can inflame and damage the lining of the esophagus although this occurs in a minority of patients. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed-up into the stomach from the duodenum. (The duodenum is the first part of the small intestine that attaches to the stomach.) Acid is believed to be the most injurious component of the refluxed liquid. Pepsin and bile also may injure the esophagus, but their role in the production of esophageal inflammation and damage (esophagitis) is not as clear as the role of acid.

GERD is a chronic condition. Once it begins, it usually is life-long. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition. Moreover, after the esophagus has healed with treatment and treatment is stopped, the injury will return in most patients within a few months. Once treatment for GERD is begun, therefore, it usually will need to be continued indefinitely.
Actually, the reflux of the stomach's liquid contents into the esophagus occurs in most normal individuals. In fact, one study found that reflux occurs as frequently in normal individuals as in patients with GERD. In patients with GERD, however, the refluxed liquid contains acid more often, and the acid remains in the esophagus longer.

Signs and Symptoms

Heartburn -- a burning sensation under the sternum in the chest -- is the primary symptom of GERD. Heartburn often occurs after a meal and worsens at night, when you are lying flat. It is more likely to occur following a heavy meal, or if you bend, lift, or lie down just after eating.
Other symptoms of GERD include:

• Regurgitation of food
• Belching
• Nausea and vomiting
• Chronic cough, wheezing
• Sore throat, hoarseness or change in voice, difficulty swallowing
• Chest pain
   

More about Heartburn

Causes

• Pregnancy
• Obesity
• Hiatal hernia (a condition in which a portion of the stomach protrudes through an opening in the diaphragm where the esophagus normally fits snuggly and passes into the stomach.)
• Recurrent or persistent vomiting
• Nasogastric tubes (these are inserted through the nose and into the stomach for a variety of medical reasons)
• Smoking cigarettes
• Some medications including calcium channel blockers (a class of meds used for high blood pressure such as amlodipine, diltiazem, felodipine, nifedipine, nisoldipine, and verapamil), anticholinergic drugs (including benztropine, biperiden, dicyclomine, hyoscyamine, isopropamide, and scopolamine), iron pills, non-steroidal anti-inflammatory drugs (NSAIDs including aspirin and ibuprofen), potassium, dopamine (for Parkinson's disease), sedatives, bisphosphonates (alendronate and risedronate for osteoporosis), and beta blockers (such as atenolol, labetalol, metoprolol, nadolol, pindolol, and propranolol, for high blood pressure or heart disease.)

Risk Factors

• Heavy meals
• Lying down or bending after a meal
• Eating immediately prior to exercise
• Prior esophageal surgery
• Esophageal stricture (narrowing of the esophagus)
• Cigarette smoking
• Alcohol intake
• Psychological stress

Diagnosis

GERD is generally not difficult to diagnose.Symptoms,medications and lifestyle are usually enough to make a clear diagnosis. If the diagnosis is unclear, one or more tests may be performed:

• Upper endoscopy,
• Called esophagealgastroduodenoscopy (EGD), which involves the insertion of a tube down the throat into the esophagus to look for signs of reflux, inflammation, ulcers, or other changes in the esophagus.
• A barium swallow, which involves visualization of the esophagus through a series of xrays following the swallowing of a substance called barium. This looks at the movement of the esophagus and whether any fluid comes back from the stomach into the esophagus.
• Manometry measures the pressure of the sphincter muscle; if low, this is consistent with GERD.

Treatment Approach
The primary goals of treatment are to reduce the reflux (regurgitation), stop the harmful effect of the stomach's materials by reducing its acid content, improve the clearance of food through to the stomach, and protect the walls of the esophagus. Pregnancy
GERD is quite common during pregnancy, particularly in the third trimesterMedications

Heartburn Medications

• Aciphex
• Nexium
• Prevacid
• Prilosec
• Protonix