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Acid Reflux disease, also known as Gastroesophageal reflux disease is a condition in which the liquid content of the stomach backs up, or refluxes, into the esophagus. This liquid usually contains pepsin, which is an enzyme that begins the digestion of protein in the stomach, and acid which is also produced in the stomach. The liquid may also contain bile from the stomach. The regurgitated liquid can eventually inflame and damage the lining of the esophagus in serious cases. The acid in the liquid is the most serious of the components. The bile and pepsin also play a role is the damage of the esophagus, but not as big a role.
In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach’s contents to flow up into the esophagus. A hiatal hernia may weaken the LES and increase the risk for gastroesophageal reflux. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the abdomen from the chest. Recent studies show that the opening in the diaphragm helps support the lower end of the esophagus. Many people with a hiatal hernia will not have problems with heartburn or reflux. But having a hiatal hernia may allow stomach contents to reflux more easily into the esophagus.
Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and over have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages.
Typical or common GERD symptoms include the following: Heartburn, Difficulty swallowing, Excessive salivation, Regurgitation, Gas and bloating, Pain or discomfort in the chest, Intolerance of certain foods and liquids, Bad breath or a sour taste in the mouth.
Lifestyle recommendation and dietary changes are required for most people needing treatment for GERD. Treatment aims at decreasing the amount of reflux or reducing damage to the lining of the esophagus from refluxed materials. Avoiding foods and beverages that can weaken the LES is often recommended. These foods include chocolate, peppermint, fatty foods, coffee, and alcoholic beverages. Foods and beverages that can irritate a damaged esophageal lining, such as citrus fruits and juices, tomato products, and pepper, should also be avoided if they cause symptoms.
Health care provider may suggest antacids for occasional heartburn. Sometimes, more potent medications such as H2 blockers and proton pump inhibitors may be needed, especially for persistent symptoms. Both prescription and over-the-counter choices are available. Rarely, surgery is recommended to prevent reflux and heartburn. The primary objective of treatment is to identify the cause of the heartburn so it can be avoided in the future
Sometimes GERD results in serious complications. Esophagitis can occur as a result of too much stomach acid in the esophagus. Esophagitis may cause esophageal bleeding or ulcers. In addition, a narrowing or stricture of the esophagus may occur from chronic scarring. Some people develop a condition known as Barrett’s esophagus. This condition can increase the risk of esophageal cancer.
Although GERD can limit daily activities and productivity, it is rarely life-threatening. With an understanding of the causes and proper treatment, most people will find relief.
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