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All about acid reflux (AKA gastroesophageal reflux disease or GERD)

Statistics

It is estimated that over 160 million people suffer from acid reflux worldwide.

That includes 8.8 million Americans and 1.8 million Britons.

Studies have shown that:

20% of North Americans

Between 8.8%25.9% of Europeans

2.5%7.8% of East Asians,

8.7%33.1% of Middle Easterners,

11.6% of Australians

and 23.0% of South Americans suffer from acid reflux symptoms weekly.

Acid reflux impacts people of all types. Heredity, weight, and age do not factor into the

likelihood of suffering from it. Even children can get acid reflux.

A medical diagnosis of acid reflux is associated with a 57% increased risk of first heart

attack within 5 years.

Symptoms

The most common symptom is heartburn, but other symptoms include:

Regurgitation (vomiting)

Bad breath

Difficulty swallowing

Coughing and/or wheezing

Hoarseness, sore throat

Non-cardiac chest pain

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Tooth enamel erosion or other dental manifestations

Prevention

Treatment for acid reflux includes over the counter medicines, prescription drugs and

even surgery.

The following lifestyle changes have been also been recommended by the Mayo Clinic

and other top medical universities and clinics to help control the condition.

Maintain a healthy weight

Avoid acidic food and drinks (alcohol, coffee, tomatoes, etc.)

Eat small, frequent meals rather than large meals

Wait 3 hours after a meal to lie down

Elevating the head of your bed 6 - 8 inches by using a bed wedge pillow

Stop smoking

Avoid increased abdomen pressure; loosen that belt or stop doing sit-up exercises

Information

- What is acid reflux?

Acid reflux occurs when stomach acid flows back up into the esophagus the tube

which moves food down from the mouth to the stomach.

The stomach lining is specially adapted to produce this acid and also to protect itself

against its own corrosive secretion but the higher gut is not protected.

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The gastro esophageal sphincter (a ring of muscle) acts as a valve by closing the

entrance of the stomach and when it fails the symptoms of acid reflux such as heartburn

are felt. This is known as dyspepsia, pyrosis or acid indigestion.

- What causes acid reflux and gastroesophageal reflux disease?

Acid reflux is common in people of all ages and we can all experience it at some time. It

is often associated with what we eat or drink but sometimes there are no reasons

(idiopathic). Recurrent reflux that leads to disease has other causes & risk factors are

termed gastro esophageal reflux disease aka GERD or GORD.

An anatomical abnormality, known as a hiatal (or hiatus) hernia allows the upper

part of the stomach to enter the chest cavity, by letting it push up through the

diaphragm - this sometimes can lead to GERD.

Pregnancy can increase the occurrence and severity of the symptoms of dyspepsia

and the likelihood is increased furthermore if one suffered from acid reflux before

pregnancy.

Controllable lifestyle factors that can be changed include; obesity (over weight),

smoking, high table salt intake, a diet lacking fibre, little or no exercise.

- Tests and diagnosis of gastroesophageal reflux disease

1) Endoscopy Camera Imaging Upper gastrointestinal endoscopy (aka esophago-gastro-duodenoscopy or EGD) visual inspection using a tube containing an optical system. Can highlight, ulcers, strictures, Barrett's and an inflamed esophagus but does not diagnose GERD.

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2) X-ray Barium swallow radiograph (esophagram) ; by swallowing a barium

solution x-rays to be taken that can but not always identify structural damage

to the esophagus.

3) Biopsy normally dependent on EGD results and the biopsy & can be carried

out at the same. Tissue samples are removed from the esophagus lining for

lab analysis that can identify more serious underlying issues such as

infections & abnormalities.

4) pH monitoring measures the amount of acid (acidity testing).

5) Oesophageal manometry - can check the function of the oesophagus and lower

oesophageal sphincter.

6) Impedance monitoring - measuring rate of fluid movement along the oesophagus

Long term risks

Untreated acid reflux and long-term exposure to the stomach acid can damage the

esophagus leading to;

Esophagitis the damaged esophagus lining may cause irritation, bleeding &

ulceration.

Strictures - acid damage can lead to scarring which may make swallowing difficult

and issues with food getting stuck as it travels down the esophagus

Barrett's oesophagus - a serious complication in which changes in the oesophagus

make its lining resemble that of the intestine further down the gut.

Both esophagitis and Barrett's esophagus are associated with a higher risk of

cancer!

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Popular Medication types

There are countless over the counter none prescriptive medications. People with

persistent symptoms should always seek professional advice.

Antacids counteract (neutralize) the acid in your stomach. Chewable tablets or

liquid form.

H2 blockers (aka histamine H2-receptor antagonists) reduce the amount of acid

produced by the cells in the lining of the acid. Can be effective as short-term on demand

relief. Over the counter and prescribed in stronger strengths.

PPIs (Proton pump inhibitors) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid. More effective and widely preferred than

H2 blockers for long term management. Over the counter and prescription versions.

Prokinetic medicines speed up the passage of food through the stomach.

Surgery In extreme cases an operation (normally performed by keyhole surgery) can tighten the lower oesophagus to prevent acid leaking up from the stomach.

Sources used:

Burden of Gastrointestinal Disease in the United States: 2012 Update, Anne F. Peery et

al, 2012. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480553/

Gastroesophageal reflux among different racial groups in the United States, H.B. El-

Serag et al, 2004. Available online at http://www.ncbi.nlm.nih.gov/pubmed/15188164

Gastroesophageal Reflux Disease, Medscape, 2014. Available online at

http://emedicine.medscape.com/article/176595-overview

Gastroesophageal Reflux Disease (GERD), University of Michigan, Faculty Group

Practice, 2013

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GERD, The Mayo Clinic, 2012. Available online at http://www.mayoclinic.org/diseases-

conditions/gerd/basics/definition/con-20025201

GERD may boost risk of MI, GI & Hepatology News, 2014. Available online at

http://www.gihepnews.com/news/top-news/single-article/gerd-may-boost-risk-of-

mi/961221c1640f6450b79a643d5bc37ea4.html

Statistics by country for Gastroesophageal Reflux Disease, 2004. Available online at

http://www.rightdiagnosis.com/g/gerd/stats-country.htm

Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review,

Hsehm B. El-Serag, Stephen Sweet, Christopher C. Winchester and John Dent, 2013.

Available online at http://gut.bmj.com/content/early/2013/07/12/gutjnl-2012-

304269.short?rss=1

http://www.medicalnewstoday.com/articles/146619.php

Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in

adults. Bethesda, Maryland, US: National Institute of Diabetes and Digestive and

Kidney Diseases. Information published online Dyspepsia in Pregnancy Available

online at http://www.patient.co.uk/health/dyspepsia-in-pregnancy

Understanding heartburn and reflux disease.

Bethesda, Maryland, US: American Gastroenterological Association. Information

published online, Symptoms and procedures to diagnose GERD available online at

http://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/page6.htm

What is acid reflux disease Available online at http://www.webmd.com/heartburn-

gerd/guide/what-is-acid-reflux-disease

Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults

http://digestive.niddk.nih.gov/ddiseases/pubs/Gerd/

http://www.nhs.uk/conditions/antacid-medicines/Pages/Definition.aspx

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