12.+GERD

= Danielle Smith =

=**Gastroesophageal Reflux Disease**= =**GERD**=


 * __[|What is Gerd]:__**

Gastroesophageal reflux disease commonly referred to as GERD or acid reflux is a chronic digestive disease where the lower esophageal sphincter (LES) does not close properly, causing the stomach contents such as food or liquid to come back up or “reflux” from the stomach up into the food pipe (esophagus). The liquid can inflame and damage the lining of the esophagus. The liquid that is pushed back up usually contains bile, acid and pepsin. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.)

Acid reflux leads to uncomplicated GERD, but not everyone with heartburn has GERD.

Sometimes, you may not feel any pain at all when reflux occurs. Heartburn is exactly what it would feel like if acid was literally eating away at the lining of your esophagus, because that is basically what is happening. The Burning, pressure, or pain of heartbutn can last as long as 2 hours and is often made worse after eating, lying down, or bending over.
 * __**Acid reflux:**__ occurs when stomach acid regurgitates up into the esophagus. Reflux is the cause of heartburn.
 * __**Heartburn:**__ is a sensation of tightness, pain or discomfort in the middle of the chest that can, but doesn't always follow an occurrence of acid reflux.




 * __Statistics of GERD:__**


 * 60 to 70 million people are affected by all digestive diseases
 * 75% of people taking conventional treatments for digestive problems CONTINUE TO EXPERIENCE SYMPTOMS – as often as 3 or more times a week!
 * Cancer of the esophagus related to heartburn and GERD is the most rapidly increasing cancer in western countries.
 * Digestive problems are the leading cause of hospitalization, surgery, and disability in the United States and affect more than 65 million Americans.


 * __[|Symptoms Of GERD:]__**


 * __Heartburn__**: usually a burning pain in the middle of the chest. Usually starts high in the stomach and rise up into the neck. The pain is usually sharp or pressure like rather than burning. Heartburn is usually related to GERD but is seen occurring more after a meal, it is also a lifelong problem and almost always comes back.


 * __Regurgitation__**: Is the appearance of reflux liquid in the esophagus, when a small amount of liquid refluxes and it remains in the lower esophagus, when there are high amounts of liquid it usually contains food and refluxes into the higher esophagus. The UES is a circular muscle that prevents liquid from backing up into the esophagus, when this happens there can be an acid taste in the mouth. Frequent or prolonged regurgitation can lead to acid-induced erosions of the teeth.


 * __Nausea__**: Some patients experience frequent to severe nausea causing vomiting. Nausea is one of the first sighs in GERD that doctors look for. Some patients with GERD develop mainly heartburn and some develop mainly nausea.

Other symptoms include: hoarseness of voice causing sore throat, laryngitis, feeling as if there is a lump in throat, and asthma.


 * __Causes of GERD:__**

The exact cause of GERD is not known and is caused by more than one factors such as:

__**LES (Lower Esophageal Sphincter)**__: This causes the reflux food particles, acid, pepsin and bile into the esophagus. This is caused when the LES acts abnormal such as weak contractions and relaxation of the esophagus.


 * [|Hiatal Hernia:]** This is a very common symptom of GERD. A small part of the upper stomach attached to the esophagus pushes up thru the diaphragm causing the stomach and LES to lie in the chest and the LES is not level with the diaphragm. This occurs at two different spots, leading to the reflux of stomach contents.




 * __Esophageal Contractions__**: When you swallow it causes a ring like wave of contractions of the esophageal muscles, which helps push food, saliva, bile and pepsin thru the esophagus to the stomach. This process is called peristaltic movement, when this process doesn’t go right it is one of the causes of GERD.

__**[|Food:]**__Avoiding foods & beverages that can weaken the LES is recommended. These foods include: fatty foods, chocolate, caffeine, mint and alcoholic drinks. Foods and beverages that can irritate a damaged esophageal lining are to be avoided as well and includes: citrus fruits and juices, tomato products and pepper should be avoided. Decreasing to size of your portions at mealtimes may also help control the symptoms. Making sure you eat your meals 2-3 hours before bedtime can lesson the reflux by allowing the acid in the stomach to decrease and the stomach to empty.


 * __Medications__**: Sedatives, tranquilizers, and medication taken for hypertension can also cause GERD. Many drugs cause relaxation of the lower esophageal sphincter or lead to improper functioning of LES resulting into GERD. Medication for asthma, high blood pressure, anxiety disorders, seizures, angina, prescription pain killers, and antidepressants all can cause GERD.

__**[|Smoking/Tobacco]**__ People who smoke are more likely to cough, which puts pressure on the LES. Cigarettes have been shown to weaken the LES. Both of these effects on the sphincter can cause it to open more often and can increase acid reflux. Tocacco products cause your body to make less saliva, which you need to help neutralize the stomach juices in your esophagus.

__**[|Lifestyle Changes:]**__


 * Dont go to bed with a full stomach: Eat meals 2-3 hr before going to bed, this gives the food time to digest and empty from the stomach.
 * Dont overeat: Watch your portion size, try eating 4-5 small meals instead of 3 large meals.
 * Eat slow: Don't rush eating.
 * Wear lose fitting clothes.
 * Avoid foods that increase heartburn.
 * Lose weight.
 * Stop smoking.
 * Avoid alcohol.
 * Keep a diary or heartburn log: Keeps track of when heartburn hits and the specific food or beverage you ate that triggered it.


 * __[|Diagnostic & Tests for GERD:]__**


 * __CITED RESOURCES__**

PubMed Gastroesophageal reflux disease Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia – GERD

National Center for Biotechnology Information, U.S. National Library of Medicine 8600 Rockville Pike, Bethesda MD, 20894 USA

© 1998-2011 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

American Gastroenterological Association website. Available at: http://www.gastro.org/. Accessed March 6, 2006. The Merck Manual of Medical Information. 17th edition. Simon and Schuster, Inc.; 2000.