The term “gastroesophageal reflux” (GER) describes the passage of stomach contents into the esophagus. Under normal conditions, the gastric or intestinal content does not pass into the esophagus, since there is a lower esophageal sphincter (LES) that acts as a valve and prevents the passage of food.
When this muscle barrier is altered or inappropriately relaxed, the gastric content passes into the esophagus, irritating the mucosa and producing different symptoms and/or complications.
What are the causes?
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 the 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?
Burning (“heartburn” in medical terms), which rises from the stomach to the throat, is the main symptom of GOR. It is possible that it is associated with the passage of acidic or bitter foods from the stomach to the mouth
It usually worsens after meals, especially with foods that promote sphincter relaxation or dietary excess. In many cases, it also gets worse during the night’s rest or when the trunk is flexed.
In some cases the predominant symptoms are respiratory: aphonia or rashes (due to irritation of the larynx by acid reflux) or even asthma or respiratory distress (by 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 frequent is esophagitis , which is the inflammation of the esophageal mucosa that is exposed to acid. There are different degrees. Severe esophagitis can: ulcerate and bleed; Heal irregularly, reducing the diameter of the esophageal lumen 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 .
DIAGNOSIS AND TREATMENT OF GASTROESOPHAGEAL REFLUX IN THE CLINIC
The initial diagnosis of gastroesophageal reflux is based on the 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 treatment are related, since the response to antisecretory therapy is considered a diagnostic criterion.
In all cases, hygienic-dietetic measures aimed at reducing intra-abdominal pressure should be adopted. Then treatment will be indicated with drugs that are very effective in most patients.
If all these measures fail, laparoscopic surgeon in Delhi can perform surgical treatment to solve the problem permanently.
What treatments do we do?
The pharmacological treatment will depend on the symptoms of the patient, especially its 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 can be indicated.
Laparoscopic 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 control symptoms.
How long should be 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 controlling the symptoms and the duration of treatment depends only on the discomfort referred by the patient.
Severe 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, surgical treatment, called fundoplication, can be chosen and can now be performed in most of the cases by laparoscopy surgery in Delhi (minimally invasive surgery).