Gastroenteric Area

Peptic ulcers
Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) occurs when gastric juices come into contact with the oesophageal wall (the segment of the food canal before the stomach), causing a burning feeling against the sternum and acid reflux. The passage of acid from the stomach to the oesophagus happens physiologically during the day, particularly after eating. However, if this happens more than it should in terms of frequency and duration, this becomes a pathology. If it happens occasionally, it can usually be managed with adequate lifestyle changes and treated with over-the-counter drugs. But, when it becomes a daily issue, it can affect the quality of life. In 30-35% of cases, the disease is complicated by erosions affecting the oesophagus (oesophagitis), ulcers or constrictions (3-5%), while in most cases it does not cause any harm.

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Symptoms

Common symptoms of GERD include:

• a burning sensation in the front and middle of your chest, behind the sternum (heartburn)
• acid reflux, i.e. feeling a sour or acid fluid in your mouth
• pain or difficulty swallowing (dysphagia)

Symptoms can be persistent throughout the whole day, or be intermittent. For example, acid reflux can occur in the morning, after meals, or during the night, only when lying down or leaning forward (e.g. when tying shoelaces).

In some cases, the disease can cause atypical symptoms such as asthma, chronic laryngitis, cough, chest pain (similar to cardiac chest pain), dental cavities, insomnia.

What is it?

Gastroesophageal reflux disease (GERD) occurs when stomach acid comes into contact with the oesophageal wall, causing heartburn and acid reflux. The passage of acid from the stomach to the oesophagus happens physiologically during the day, particularly after eating. However, if these events exceed a certain threshold, in terms of frequency and duration, this becomes a pathology. If it happens occasionally, it is usually managed with adequate lifestyle changes and treated with over-the-counter drugs. When it becomes a daily issue, it can affect the quality of life. In 30-35% of cases, the disease is complicated by an erosions of the oesophagus (oesophagitis), ulcers or strictures (3-5%), while in most cases it does not cause any harm.maggior parte dei casi non determina lesioni.

Risk Factors

What are the causes and risk factors?
This condition is caused by acid flowing back from the stomach to the oesophagus due to a loss of pressure of the lower oesophageal sphincter (the passage between the oesophagus and the stomach). The pressure at the junction between the oesophagus and stomach is influenced by diet, circulating hormones and certain medications. An increase in intra-abdominal pressure in people who are overweight or in pregnant women, can contribute to the development of acid reflux. Some anatomical anomalies can also play a role in causing heartburn, such as hiatal hernia, which occurs when the upper part of the stomach and its valve move above the diaphragm.

Treatment options

Can gastroesophageal reflux disease be treated? Initial treatment for gastroesophageal reflux disease is based on lifestyle changes:

• follow a healthy diet to reduce body weight
• avoid smoking and foods that may cause acid reflux
• avoid going to bed immediately after meals, especially after big or heavy meals (you should wait a minimum of 3 hours)
• eat a smaller evening meal.

If symptoms persist even after these lifestyle changes, you can used anti-acid medications as a remedy for symptoms, to neutralize stomach acid.

Proton pump inhibitors (PPIs) are the first choice of treatment for gastroesophageal reflux disease thanks to their ability to almost completely inhibit the secretion of acid. PPIs reduce acidity by blocking the “pumps” located inside acid-secreting cells. These medications are also useful to heal esophageal tissue that has been eroded.

Surgery as a treatment for gastroesophageal reflux disease is considered an “extreme” measure, and it is reserved to patients who do not respond to medications and have underlying medical problems, such as large hiatal hernias.

Diagnosis

How is it diagnosed?
Typical symptoms (heartburn and acid regurgitation) are enough to make a diagnosis of gastroesophageal reflux disease.
If there are no improvements after a short period of treatment with gastroprotectors, or if there are “warning” symptoms such as weight loss, weakness, or anaemia, some diagnostic tests may be necessary. Tests used to diagnose this condition include:

• gastroscopy (EGDS): it allows doctors to examine the oesophagus, stomach and duodenum by introducing an optical probe through your mouth, equipped with micro-cameras that transmit images on a screen. It is a simple and safe examination that also allows your doctor to collect small samples of the mucous membrane to check for the presence of esophagitis (biopsy).
• X-ray of the upper digestive system: the patient has to drink a small amount of off-white contrast liquid which allows doctors to examine the anatomy and function of the oesophagus, stomach, and upper tract of the small intestine.
• Esophageal manometry: a probe is inserted through your nose while you swallow water in small sips. It can be useful to assess the motility of the oesophagus (peristalsis).
• 24 hour pH-impedance test: a small, thin probe is passed through your nose down to the oesophagus while connected to a hand-held device. The test lasts 24 hours and it monitors the amount of reflux (both acidic and non-acidic) in your oesophagus.

Lifestyle and diet
A healthy lifestyle is essential to both prevent and treat the condition.
You should maintain a healthy weight and follow a healthy diet, avoiding foods that are rich in fats or “refluxogenic” foods, i.e. foods which may cause the symptoms of reflux.
• chocolate, tea, coffee, greasy foods, fried foods, garlic, onion, mint-flavoured foods, and spicy foods can release the pressure on the valve separating the oesophagus from the stomach, facilitating reflux;
• citrus fruits, tomato-based foods such as pasta, chili, and pizza sauce, which are acidic and therefore increase the amount of acid in the stomach;
• fizzy drinks: carbon dioxide contained in fizzy drinks can swell the abdomen and increase the likelihood of reflux.
• alcoholic drinks and desserts tend to irritate the oesophagus.

Gastroenteric Area

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Risk Factors

Treatment options

Diagnosis

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