Gastroesophageal Reflux Disease (GERD) or Heart Burn and Its Treatment

By gastroesophageal reflux disease (GERD, acidic reflux disease) content from the stomach is frequently pushed up into the esophagus and sometimes all the way into the mouth. The content can also sometimes be aspirated down into the throat and the windpipe.

Since there is a high concentration of acid (HCl) and digestive enzymes in the stomach content, it will irritate or hurt the esophagus, mouth or throat. It will give acute burning pain and can cause chronic inflammation and eventually also structural damages in these organs.

THE MECHANISMS OF THE DISEASE

Several mechanisms can cause acid reflux and thereby heartburn, either solely or in combination:

- The sphincter (a circular muscle) that normally closes the entrance from the esophagus into the stomach can be too lax or it can be be abnormally shaped so that stomach content leaks upwards.

- Hiatal hernia can cause GERD. By this condition the upper part of the stomach has been pressed up through the passage in the diaphragm into the thoracic cavity.

- The digestion of food in the ventricle may be too slow, causing the ventricle to empty too late and eventually get over-filled.

- The ventricle can contract too much or have cramps, like when one throws up.

- The portal muscle between the stomach ventricle and the duodenum (upper part of the small intestine) can be too narrow or constrict too strongly so that content fills up in the ventricle and makes an over- pressure here.

- Any situation that increases the pressure in the abdominal cavity can contribute to GERD.

- The heartburn and other symptoms of GERD can be associated with a too high production of salty acid (HCl) in the ventricle.

- Also people with normal stomach function seem to have some degree of reflux. In many sufferers of GERD increased production of acid therefore seems to be the only component of the disease.

PRIMARY CAUSES OF GERD

The primary causes of these mechanisms and thereby GERD can also be many:

- Anomalies in the gastroesophageal sphincter or other places in the stomach region causing reflux can be congenital.

- Consuming too much coffee, tea, alcoholic beverages, citrus juices, tomato juice, carbonated beverages, chocolate, peppermint and other spices can cause GERD. But a more moderate consume of coffee, tea and spices may have a good effect on the digestion.

- People that consume great amounts of fatty food, refined sugar and refined floor will often acquire acid reflux.

- Acidic reflux is sometimes associated with smoking and with use of certain drugs, like cocaine.

- Frequent physical strain of certain kind, like heavy lifting when bending down, frequent coughing or labor during delivery can increase the pressure in the stomach and cause reflux.

- A history of stomach ulcers or inflammations can give the kind of abnormalities in the stomach that cause GERD.

- Nervous problems caused by stress or physical neurological anomalies can affect the nervous control of the stomach and the sphincter and lead to frequent regurgitation of stomach content

TREATMENT OF GERD

Lifestyle measures are often the first treatment one tries to help against GERD. If these are not enough, drugs of various kind can be used, and as a last resort surgery is sometimes performed. Possible measures against GERD are:

- It can be useful to reduce the consume of coffee, tea, alcoholic beverages, citrus juices, tomato juice, carbonated beverages, chocolate, peppermint and other spices. It is however not necessarily wise to avoid consume of coffee, tea and spices totally

- Stopping or reducing smoking may help against GERD.

- Reducing the consume of food with much added sugar or of sweet snacks and cookies may help. It may also help to eat full corn bread and cereals instead of products based on refined flour.

- Lying with the upper body and head high can often hinder reflux during night or rest. Reducing the meals before bedtime can also help..

- Relaxing measures like meditation or measures to avoid stress can often alleviate the problem.

- Chewing gum after meals may alleviate GERD, because this action stimulates the production of acid-neutralizing saliva and the swallowing down of the regurgitated stomach content

- Acute symptoms of GERD can be alleviated with drugs containing acid-neutralizing substances. Most of these are based on salts of aluminium, magnesium or calcium.

- Sometimes drugs that modify the acid secretion are used. A class of these drugs blocks the action of the tissue hormone histamine that commands the release of acid - the so-called H2 receptor blockers (cimetidine, famotidine, nizatidine, ranitidine). Another class, proton pump inhibitors, blocks the production of acid directly (esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole) These.last drugs also help against the inflammation and damages done by the reflux.

- There are also drugs than can stimulate the function of the muscles in the upper digestive system, so that the gastroesophageal sphincter contracts better and the stomach empties itself faster (metoclopramide).

- One drug (Gaviscon) works partly by producing a foam that will lie upon the top of the stomach content and block the regurgitation, and partly by neutralizing the acid.

- Substances that can improve the digestion chemically can sometimes help, like supplements of gastric enzymes.

- There also exist herbs or natural substances with the ability to reduce acid reflux and help heal damages from acid reflux, like Aloe vera, Picrorhiza, orange peel, and licorice. Often such substances are blended to give the wanted effects.

- When hiatal hernia causes severe reflux, a surgical procedure called Nissen fundoplication is sometimes performed.