Gastroesophageal reflux disease

Causes and Risks:
Gastroesophageal reflux is a normal condition that occurs during the waking hours, especially after meals. However, in symptomatic people, the reflux is related to an incompetent lower esophageal sphincter, a band of muscle fibers that closes off the esophagus from the stomach. Acidic or alkaline gastric contents return to the esophagus through the lower esophageal sphincter and cause the symptoms. Conditions associated with incompetent esophageal sphincters are pregnancy , hiatal hernia , obesity , recurrent or persistent vomiting , and nasogastric tubes. The risk factors include previous esophageal surgery, or esophageal stricture . The incidence is 5 out of 1,000 people.

Symptoms:



Signs and Tests:



Treatment:
General measures include:

  • weight reduction
  • avoiding lying down after meals
  • sleeping with the head of the bed elevated
  • taking medication with plenty of water
  • avoiding dietary fat , chocolate, caffeine , peppermint (they may cause lower esophageal pressure)
  • avoiding alcohol and tobacco

Medications that alleviate symptoms include:

  • antacids after meals and at bedtime
  • histamine H2 receptor blockers
  • promotility agents
  • proton pump inhibitors

Antireflux operations ( Nissen fundoplication ) may be indicated for a small number of patients who have persistent symptoms despite medical treatment.

Prognosis:
85% of people respond to nonsurgical measures.

Complications:



Call Your Healthcare Provider:
Call your health care provider if the symptoms worsen or do not improve after using general measures.


This illustration shows the major organs of the digestive system. Their relative sizes and positioning in the body are also demonstrated.