Medtrix

Many people experience a peculiar pain and burning sensation on their chest or upper abdomen which most times is confused as an ulcer. There’s sometimes a silent player on this field called GERD.

Gastresophageal Reflux Disease (GERD) is a disorder associated with backflow of stomach contents into the esophagus and mouth. It’s quite common to have acid reflux once in a while, often presenting after overeating, assuming wrong posture after eating, or eating certain foods. 

Gastroesophageal reflux disease has other causes and risk factors which can lead to serious complications. GERD can also occurs in people of all ages, and sometimes for unknown reasons. It is common, particularly in western countries and has been reported by few studies to be rare in Africa. However, a recent study in 2009 by Nwokediuko, of Nigerian medical students  showed a prevalence of 26.3% of which the Non-Erosive Reflux Disease (NERD) classification accounts for majority of GERD cases in Nigeria.

CLASSIFICATION

There are two forms of GERD 

• Erosive Reflux Disease (ERD) which is the presence of classic GERD symptoms and esophageal mucosal injury.
• Non-Erosive Reflux Disease (NERD) which is defined as the presence of classic GERD symptoms without esophageal mucosal injury during upper endoscopy. 

RISK FACTORS FOR REFLUX DEVELOPMENT

Many potential risk factors are associated with the development of GERD some of whic includes:

Hiatus Hernia

Hiatus hernia occurs when the junction between the esophagus and the stomach (the gastresophageal junction) is displaced. The gastresophageal junction normally acts as a barrier to backflow of stomach contents into the esophagus. Patients with hiatus hernia have more episodes of reflux and more severe reflux esophagitis.

Obesity

Overweight or obese individuals, especially those with central adiposity (abdominal obesity) are at higher risk of developing GERD and it’s complications. Abdominal obesity increases pressure on the stomach, which favors the development of reflux. Obese people are at higher risk of developing hiatus hernia, leading to GERD.

High Fat Diet

High fat diets increase the episodes of reflux in GERD patients as compared with low fat diets. Foods that are high in fat promote the release of cholecystokinin, a hormone that relaxes the lower esophageal sphincter and causes acid backflow. This hormone also encourages food to stay longer in the stomach for better digestion thereby increasing the chances of acid reflux.

Tobacco Smoking

Many studies have linked tobacco smoking to the development of GERD. This risk is evident in both current and former smokers and increases with the duration of smoking as well as the amount of tobacco smoked.

Alcohol Consumption

A number of cohort studies have shown that alcohol consumption is not associated with an increased risk of GERD. However, based on some evidence, moderate to high alcohol consumption (>7 alcoholic drinks per week) may increase the risk of GERD.

Pregnancy

GERD is reported by 40%–85% of pregnant women. This most likely due to increased progesterone level, causing relaxation of the muscle that controls the lower esophagus. Pregnancy can either precipitate GERD symptoms or worsen existing GERD. The onset of GERD during pregnancy is usually toward the end of first trimester and sometimes it lasts throughout the remainder of pregnancy, often worsening as the pregnancy ages. While symptoms can be severe, they usually resolve after pregnancy, and complications from GERD during pregnancy are not likely to develop.

Genetics

Evidence supports a genetic cause for GERD. Studies indicate that the probability of GERD between identical twins is 43% and for nonidentical twins, 26%.

Medications

A number of medications can cause GERD symptoms as well as lead to esophageal  injury including: antibiotics (e.g, tetracyclines and clindamycin), nonsteroidal antiinflammatory drugs, statins, vitamin C, potassium, iron, anticholinergics, tricyclic antidepressants, corticosteroids (oral and inhaled), β-agonists, benzodiazepines, warfarin, calcium channel blockers, etc.

Certain foods

Consumption of spicy foods, coffee, carbonated beverages, chocolate, citrus products and tomato products may increase GERD risk. In Nigeria, increased consumption of cola and coffee by students in order to stay awake to read for examinations is associated with an increased prevalence of GERD.

Gender

Some studies have shown that GERD symptoms are more prevalent in males than females but complications from GERD do appear to be more prevalent in males.

SYMPTOMS OF GERD

The presence of heartburn and regurgitation is characteristic of most cases of GERD. Heartburn is experienced at least daily in 24% of people with GERD and once or twice weekly in 43% . Predominance of either heartburn or regurgitation is sufficient for a GERD diagnosis.

• Heart burn

Heart burn is a burning sensation behind the breast bone, caused by stomach acids entering the esophagus. 

• Regurgitation

This is the back flow of stomach contents into the mouth or hypopharynx.

In the absence of either of these symptoms, GERD becomes more difficult to diagnose. Diagnostic tests are used when the diagnosis is in doubt or complications are a concern.

– Other symptoms include cough, laryngitis, asthma, teeth erosion, pharyngitis, sinusitis, idiopathic pulmonary fibrosis, and recurrent inflammation of the middle ear.

COMPLICATIONS

One of the most common complications of GERD is esophagitis (inflammation of the esophagus). With long-term uncontrolled acid reflux, Barrett’s esophagus may also develop. Barrett’s esophagus is a strong risk factor for developing cancer of the esophagus (esophageal adenocarcinoma). The rate of occurrence of cancer of the esophagus has increased rapidly, and this has been traced to obesity epidemic, GERD and Barrett’s esophagus.

TREATMENT OF GERD

• Lifestyle Modifications

This is recommended as first-line therapy for all GERD patients. It includes elevation of the head of the bed, weight loss, and avoidance of alcohol, tobacco, caffeine, chocolate, spicy foods, acidic foods, and fatty foods.It is also recommended that people should:

– Eat moderate amounts of food and avoid overeating.

– Stop eating 2 to 3 hours before sleeping.

– Not wear clothings that are tight around the abdomen.

• Medications

The primary medications used for GERD are proton-pump inhibitors, H2 receptor blockers and antacids with or without alginic acid. Heart burn is relieved by simple antacids.

RECOMMENDATION

Although esophageal reflux is a normal physiologic occurrence, individuals with consistent reflux should seek medical attention to rule out GERD.

Stay safe!

Maureen