Gastroesophageal reflux is the return of gastric juices from the stomach into the esophagus, the tube through which liquids and food flow from the mouth to the stomach. When symptoms occur several times a day and are associated with other disorders, we can talk about gastroesophageal reflux disease (GERD).
What are the causes of gastroesophageal reflux?
There are dietary factors or ways of life that can contribute to gastroesophageal reflux.
Chocolate, pepper or spices, mint, fats, coffee and alcoholic beverages favor relaxation of the lower esophageal sphincter and, therefore, reflux. Tobacco also produces sphincter relaxation.
The existence of a hiatus hernia favors gastroesophageal reflux, although it is not its only cause.
All those situations that involve an increase in intra-abdominal pressure (obesity, pregnancy, certain types of physical exercise) also favor reflux.
What are the symptoms of gastroesophageal reflux?
Burning or burning (“heartburn” in medical terms), which ascends from the stomach into the throat, is the main symptom of GER. It may be associated with the passage of acidic or bitter foods from the stomach to the mouth
It usually gets worse after meals, especially with foods that favor sphincter relaxation or with dietary excesses. In many cases, it also gets worse during nighttime rest or when the trunk is flexed.
In some cases the predominant symptoms are respiratory: aphonia or carraspera (due to irritation of the larynx due to refluxed acid) or even asthma or respiratory distress (due to aspiration of the acid into the respiratory tract).
What are the complications?
There are several complications derived from reflux, although these do not occur in most cases. They depend on the severity of the reflux in each subject.
The most common is esophagitis, which is the inflammation of the mucosa of the esophagus that is exposed to acid. There are different grades. Severe esophagitis can: ulcerate and bleed; Heal irregularly, reducing the diameter of the esophageal light and hindering the passage of food.
In some cases, a change of the normal esophageal mucosa may occur, which is replaced by a mucosa more similar to that of the stomach or the small intestine, more resistant to acid. This situation is known as ” Barrett’s esophagus ” and its main importance is that it is considered a risk factor for developing esophageal cancer.
Dietary and postural measures
These measures allow, in many cases, adequate control of symptoms:
- Avoid foods and drinks that favor relaxation of the ERA, including fats (especially fried), pepper and spices, chocolate, alcohol, coffee, citrus fruits, tomatoes, and menthol products.
- Lose weight in case of obesity.
- Give up smoking.
- Raise the head of the bed about 10 cm. It is important NOT to place pillows, which only manage to flex the neck. It is about getting an inclination of the entire trunk, that’s why articulated beds are recommended or placing wooden dowels on the front legs of the bed.
- Avoid going to bed before having spent 2 or 3 hours of intake.
Dietary and postural measures should be maintained despite following pharmacological treatment, since it has been shown that they help significantly to good clinical control of the disease.
Can it be prevented?
Nutrition plays an important role in the treatment and prevention of gastroesophageal reflux. Among the foods to avoid are sausages, alcohol, cheese, tea, coffee, tomatoes, citrus fruits, soft drinks, and fried foods. Milk, the “grandmother’s remedy” par excellence against reflux, actually favors it, since it is a high-fat food that could slow stomach emptying. It is advisable to eat slowly, chewing the food well to promote digestion and make 4 to 5 small meals a day. In addition, it is advisable to avoid going to sleep immediately after eating. Finally, you should avoid taking certain medications, such as nonsteroidal anti-inflammatory drugs and some anxiolytics that can increase gastric acidity, and wear clothes that are too tight.
Diagnosis and treatment of gastroesophageal reflux in the clinic
The initial diagnosis of gastroesophageal reflux is based on symptoms. However, if these are daily or it is necessary to maintain pharmacological treatment for more than 2-3 weeks, it is convenient to perform explorations aimed at knowing:
- Existence or not of reflux.
- Existence or not of complications derived from reflux.
- Discard other lesions that clinically resemble reflux and have a different treatment and prognosis.
In gastroesophageal reflux, diagnosis and gastroesophageal reflux disease treatment in Delhi are related, since the response to antisecretory therapy is considered diagnostic criteria.
In all cases, hygienic-dietary measures should be taken to reduce intra-abdominal pressure. Then treatment with drugs that are very effective in most patients will be indicated.
If all these measures fail, surgical treatment can be performed to solve the problem definitively.
The doctor can study reflux through different diagnostic tests:
- Gastroscopy: lets you know if esophageal inflammation (esophagitis) has occurred and its severity. It also allows biopsy samples to be taken in case of finding lesions and ruling out other diseases that can simulate reflux.
- Esophageal manometry: a probe studies how the esophagus moves when the patient swallows fluids.
- X-rays with contrast: a liquid is administered orally, which is opaque and can be seen by X-rays, and the passage of the esophagus into the stomach and the existence or not of reflux into the esophagus are studied.
- 24-hour pH metry: consists of inserting a probe through the nose with a system in the tip that detects the pH in the esophagus and / or stomach. It lets you know when episodes of reflux occur, how long they last, whether or not they relate to the symptoms, etc.
What is the treatment?
The drug treatment depends on the patient’s symptoms, especially their frequency and severity. Sometimes it is enough to take antacids, although in some cases it is necessary to block the acid secretion of the stomach. If there are symptoms of regurgitation, prokinetic drugs that increase esophageal motility may be indicated.
Surgery will be indicated in those cases in which there are serious complications arising from reflux or there is a need for high doses of drugs to manage the symptoms.
How long should the treatment be maintained?
In principle, reflux is a chronic disease and, as such, requires maintenance treatment, although this depends on the severity of the reflux and the existence of complications.
In general, mild and uncomplicated cases only require control of symptoms and the duration of treatment depends only on the discomfort referred by the patient.
Serious or complicated cases require maintenance treatment even if there are no symptoms.
When a long-term pharmacological treatment is necessary or in the case that very high doses of anti-secretory drugs are necessary, a surgical gastroesophageal reflux disease treatment in Delhi, called fundoplication, can be chosen and currently can be performed in most of cases by laparoscopy (minimally invasive surgery).