Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus A typical symptom is heartburn.

GERD is usually caused by changes in the barrier between the stomach and the esophagus, including abnormal relaxation of thelower esophageal sphincter, which normally holds the top of the stomach closed; impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. These changes may be permanent or temporary ("transient").

Signs and symptoms

The most-common symptoms of GERD are:

• Heartbun
• Regurgitation
• Trouble swallowing

Less-common symptoms include:

• Pain with swallowing
• Excessive salivation (also known as water brash) is common during heartburn, as saliva is generally slightly alkaline and is the body's natural response to heartburn, acting similarly to an antacid)
• Nausea
• Chest pain

Several other atypical symptoms are associated with GERD, but there is good evidence for causation only when they are accompanied by esophageal injury. These symptoms are:

• Chronic cough
• Laryngitis (hoarseness, throat clearing)
• Asthma
• Erosion of dentalenamel
• Dentine hypersensitivity
• Sinusitis and damaged teeth

Treatment

Three types of treatments exist for GERD. These include lifestyle modifications, medications, and surgery.

Medications

A number of drugs are approved to treat GERD, and are among the most prescribed medication in Western countries.

• PPIare the most effective in reducing gastric acid secretion. These drugs stop acid secretion at the source of acid production, i.e., the proton pump.
• GastricH2receptor blockers can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all GERD patients. Compared to placebo (which also is associated with symptom improvement), they have a (NNT) of eight (8).
• Antacids before meals or symptomatically after symptoms begin can reduce gastric acidity.
• Alginic acid may coat the mucosa as well as increase pH and decrease reflux. A meta-analysis of randomized controlled trials suggests alginic acid may be the most effective of non-prescription treatments with a NNT of four.
• Prokinetics strengthen the lower esophageal sphincter (LES) and speed up gastric emptying
•  Carafate is also useful as an adjunct in helping to heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two (2) hours apart from meals and medications.
• Baclofen is an agonist of GABA_B receptor. In addition to its skeletal muscle relaxant properties, it has also been shown to decrease transient lower esophageal sphincter relaxations at a dose of 10mg given four times daily. Reductions in esophageal relaxation clinically reduce episodes of reflux.