Reflux - an uncomfortable condition

Reflux is the word used to describe what happens when the stomach contents come back up into the gullet or even into the mouth. The medical name for gullet is oesophagus (spelt esophagus in the US). So the long name for reflux is gastro-oesophageal reflux disease. Short Terms is GORD in the UK and GERD in the States. The lining of the stomach protects the stomach from the effects of its own acids. Because the esophagus lacks a similar protective lining, stomach acid that flows backward (refluxes) into it causes heartburn (also called dyspepsia). Many people experience heartburn occasionally; however, people who get severe heartburn several times a week are considered to have GERD. The condition affects 29% of people in Canada.

Causes of GERD: GERD occurs when the sphincter, a valve that normally keeps acid in the stomach, isn't functioning properly. Food that causes GERD include:

• alcoholic drinks
• chocolate
• coffee, tea, cola
• foods with high acid content (e.g., tomatoes, orange juice)
• fried or fatty foods
• garlic
• onions
• peppermint
• spicy foods

Other factors that may contribute to GERD include:

• obesity
• abnormal lower esophageal sphincter
• abnormal esophageal contractions
• slow emptying of the stomach
• pregnancy
• smoking
• Anatomical abnormalities such as a hiatal hernia may also contribute to GERD.

Symptoms:

• The child may become hoarse, have a raspy voice, or a chronic cough.
• Recurrent pneumonia
• Regurgitation
• Nausea
• Wheezing
• Difficult or painful swallowing
• Vomiting
• Sore throat
• Weight loss
• Heartburn

Complications of GERD:

• Ulcers: The liquid from the stomach that refluxes into the esophagus damages the cells lining the esophagus. The body responds in the way that it usually responds to damage, which is with inflammation (esophagitis). Ulcers and the additional inflammation they provoke may erode into the esophageal blood vessels and give rise to bleeding into the esophagus. Occasionally, the bleeding is severe and may require blood transfusions, an endoscopic procedure and surgical treatment.
• Strictures: Ulcers of the esophagus heal with the formation of scars (fibrosis). Over time, the scar tissue shrinks and narrows the lumen (inner cavity) of the esophagus. This scarred narrowing is called a stricture.
• Cough and Asthma.
• Dental problems such as an increased risk of cavities or teeth damage, due to the acid reflux.
• Barrett's hyperplasia or Barrett's esophagus, which occurs when abnormal healing takes place after an ulcer has destroyed an area of the esophageal lining.

Treatment: One of the simplest treatments for GERD is referred to as life-style changes, a combination of several changes in habit, particularly related to eating.

• eat smaller meals more frequently, instead of two or three large meals
• eat meals earlier, especially dinner
• avoid lying down within two or three hours after meals
• reduce alcohol and caffeine intake
• stop smoking
• lose excess weight
• exercise regularly
• place the head of your bed six inches higher than the foot of the bed

Medications:

• Antacids
• Foaming agents, such as Gaviscon
• H2 blockers
• Proton pump inhibitors
• Prokinetics

Surgery: Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms.

• Fundoplication
• Endoscopic techniques

Important Things to remember:

• Frequent heartburn, also called acid indigestion, is the most common symptom of GERD in adults.
• You can have GERD without having heartburn.
• If you have been using antacids for more than 2 weeks, it is time to see your health care provider.
• Many people with GERD also need medication. Surgery may be considered as a treatment option.
• Most infants with GER are healthy even though they may frequently spit up or vomit.

Do visit in case you suffer from any of the above symptoms. Precaution is always better than cure.

(Sources: babycentre.co.uk, digestive.niddk.nih.gov, medicinenet.com, chealth.canoe.ca)