Gastroesophageal reflux

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What is it?
The esophagus is the part of the digestive system that connects the mouth to the stomach. It is separated from it by a valve which is the lower esophageal sphincter, or Cardia and that serves to prevent gastric acid to flow from the stomach.
Gastroesophageal reflux is a condition in which the lower esophageal sphincter is abnormally relaxed and allows the contents of the stomach (gastric acid) reflow and climb through the esophagus.
How is it produced?
There are a number of acids necessary for digestion of food in stomach and which do not damage the gastric walls because they have adequate protection. The esophagus continues with the stomach and is separated from him by a valve called the lower esophageal sphincter (Les), of muscle tissue, and prevents stomach contents out of the stomach.
Under normal conditions this acid remains in the stomach and does not go up into the esophagus through the valve function of one-way street that has the lower esophageal sphincter, allowing food to enter but gastric acid does not reflow. When the function of the sphincter failure (decreases its tone or strength), the effect of valve is ineffective and reflux occurs. This problem increases when the stomach is very full (after a generous meal) and when the pressure on the stomach is higher.
There are a number of factors that favor the presence of gastroesophageal reflux disease because they increase the pressure on the stomach or decrease the muscle tone of the sphincter:
Excess weight.
Lie down right after meals.
Certain how spicy foods, chocolate, peppermint and coffee.
Adjusted and tight clothes.
Some medicines.
The most typical symptoms of reflux are heartburn and regurgitation, secondary to the presence of acid in the esophagus.
The patient with reflux can present:
Heartburn which patient referred to him as “burning” or “burning”. It occurs typically in the “pit of the stomach” or you may notice in the throat (since gastric contents rises to over above). It is the predominant and characteristic symptom. It usually appears after meals and usually lasts a few minutes. These discomfort increases with Flex and the inclination of the body and food. More frequent or worse at night when going to sleep we.
Regurgitation, is the feeling of return of gastric contents into the mouth and throat.
Flavor or bitter taste in the mouth.
Pain in the pit of the stomach.
“Bad breath” frequent and dental problems caused by reflux.
Nausea and vomiting.
Other symptoms that usually appear when the disease is advanced are:
Weight loss.
Bleeding and vomiting blood.
Dysphagia: difficulty swallowing.
Reflux is also responsible for other manifestations extraesofagicas such as chronic cough, breathing problems, laryngitis, dental erosions, pharyngitis and sinusitis
The most frequent esophageal complication of Gerd is oesophagitis, i.e., inflammation of the mucosa or inner lining of the esophagus. Another complication is the appearance of precancerous lesions due to chronic injury to the lining of the esophagus (Barrett’s esophagus).
The frequency with which the symptoms appear is variable. Symptoms usually occur usually after consuming a large meal and alcohol consumption.
The diagnosis of gastroesophageal reflux disease is fundamentally based on the clinical history of the patient and the presence of typical symptoms. A series of additional tests confirmed the disease, rule out other possible diseases and evaluate the degree of the same.
Major scans that are performed are:
Gastroscopy: Consists of introducing a tube that has a small camera through the mouth and esophagus, allowing direct visualization. It is the most effective test to check the damage caused by reflux. Endoscopy allows you to see the existence of esophagitis (inflammation) and rule out other injuries (such as ulcers and tumors).
Metry: it is a test which is a measurement of the ph or the amount of acid that passes from the stomach into the esophagus for 24 hours. Lets see when episodes, the number and duration occur.
Esophageal manometry: measuring the pressure of the lower esophageal sphincter.
The treatment of the disease will vary depending on the intensity of the symptoms. In cases of occasional mild discomfort often enough certain lifestyle changes and antacids (less powerful drugs).
When reflux manifests itself with symptoms often must resort to more powerful drugs.
So the treatment of gastroesophageal reflux is based on: higienico-dieteticas measures, drug therapy and surgical treatment.
1. Dietary, postural advice
-Reduce weight if there is overweight.
-Do not put belts or girdles and tight clothes that increase abdominal pressure.
-Avoid certain foods and medications (spicy, fatty, chocolate, peppermint, tomato products, citrus) which decrease lower esophageal sphincter tone.
-Avoid lying down after meals. Wait at least a couple of hours.
-Raise the head of the bed (not just the pillow) 10 to 15 cm at night by placing a block under the same. It decreases the amount of acid that goes up into the esophagus.
-Avoid coffee, tobacco and alcohol (decreases the pressure of the lower esophageal sphincter and facilitate reflux).
2 Pharmacological treatment
Medical treatment aims to eliminate the symptoms and prevent the complications of long-term reflux. Drugs that neutralize acid secretion of the stomach are used.
Antacids. They relieve reflux, they are only indicated when suffer these discomforts occasionally.
Proton pump inhibitors. They are the drugs of choice in severe reflux, since they eliminate the symptoms and cure the mucosa of the esophagus in a high percentage of cases. The dose and duration of treatment must be adjusted in each patient, the symptoms usually disappear within 4 weeks.
AntiH2. They improve symptoms and decrease the flow of stomach acid. They are less effective than inhibitors Proton pump, especially in cases where there is important to esophagitis (inflammation of the oesophagus).
Prokinetic drugs that facilitate gastrointestinal motility.
It is necessary to perform endoscopies of control to ensure that esophagitis disappears.
3. Surgical treatment
Surgical treatment, would in some cases be indicated for example, when the patient cannot take the medication, when there are serious complications or treatment with drugs should be chronic. The goal of surgery is to performed an anti-reflux mechanism. He was known as fundoplication and consists of making a spice of scarf with the stomach around the esophagus and thus tighten the sphincter improving the function of valve.
Preventive measures include avoiding overweight, diet, healthy, light, low in fat and avoid tobacco. Once reflux appears must be treated to avoid serious complications.

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