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Gastroesophageal reflux disease - GERD, or gastric reflux disease, is a chronic condition
where stomach acid flows back up and damages the mucosa of the food pipe – the esophagus.
At the junction between the esophagus and the stomach is the lower esophageal sphincter
- the LES. The LES is a ring of muscle that is generally closed tight to prevent stomach
acid from coming up. In normal digestion, the LES only opens briefly with each swallow
to allow food bolus to pass down into the stomach. GERD occurs when the LES is ABNORMALLY
relaxed and cannot close properly. Heartburn is a burning sensation in the chest associated
with each regurgitation of gastric acid and is the most prominent symptom of GERD.
Hiatus hernia is believed to be another cause of GERD. Hiatus hernia is a condition where
the top portion of the stomach is pulled up forming a herniation above the diaphragm.
This situation somehow compromises the barrier between the esophagus and the stomach, facilitating
acid reflux. If left untreated, GERD can lead to a number
of complications, including: - Esophageal stricture - narrowing of the
esophagus as scar tissue builds up from reflux damage. The resulting narrowed food pathway
may cause difficulty swallowing. - Esophageal ulcer – open sore as a result
of acid erosion. An ulcer may bleed, cause pain and again make swallowing difficult.
- Barrett's esophagus - precancerous changes to the esophagus. These changes are associated
with an increased risk of esophageal cancer. GERD can be treated with dieting, life style
changes and medication. Patients are advised to maintain a healthy weight; avoid alcohol,
tobacco and foods or drinks that trigger heartburn; wait at least 3-4h after eating before going
to bed; and sleep with an elevated head position. Drugs of choice include proton-pump inhibitors,
which act to reduce gastric acid production. If these fail, a surgery may be recommended.
In a procedure called fundoplication, the top portion of the stomach is wrapped around
the lower esophagus and sewn into place. With this configuration, the muscles in the wall
of the stomach reinforce the closure of the esophagus. This surgical procedure is particularly
recommended when hiatus hernia is present as this can be fixed at the same time.