Gastroesophageal reflux disease (GERD)
By Marco Antonio Gordillo Mörath
The digestive tract is divided into three segments:
1. The superior segment, which begins inside the mouth and leads through the esophagus to the stomach and duodenum;
2. The middle of the digestive segment begins at the end of the duodenum, which includes the entire small intestine up to the beginning of the large intestine;
3. The inferior segment, including the entire large intestine to the rectum and anus.
We are referring exclusively to the superior digestive tract: esophagus, stomach and duodenum.
Definition and Symptoms
Gastroesophageal reflux disease (GERD) is produced by the stomach contents returning to the esophagus because a deficiency exists in the antireflux barrier. This typical, multiple symptoms such as acidity, regurgitation, heartburn, feeling of emptiness at the entrance of the stomach, hiccups and belching. The atypical symptoms are cough, hoarseness, pain in the center of the chest which may simulate “a heart attack” or a feeling of asphyxiation because the reflux substance enters the respiratory tract. The alarming symptoms can be due to the difficulty of swallowing and the diminishing size of the esophagus because of chronic inflammation. Vomit has a reddish brown color and feces are black.
What is the difference between the stomach and esophagus?
The esophagus is a muscular tube which pushes the chewed food towards the stomach. Its inner wall is smooth, thin and sensitive to the acidity of the stomach and the bile coming from the duodenum. On the other hand, the stomach is wrinkled and thick and functions to digest the nutrients into smaller components, which then can be absorbed. At the end of the stomach there is the duodenum, which is connected through the pilorum valve. In the duodenum, bile is secreted as well as the pancreatic fluids.
What is the antireflux barrier?
It’s a bidirectional valve between the esophagus and stomach, which is made up of a different muscular structure called inferior esophageal sphincter (IES) which permits the coordinated entrance of nutrients when swallowed into the stomach but inhibits their exit to the esophagus.
What produces esophagitis and gastritis?
The prolonged exposure to chloride acid and/or bile coming from the stomach to the esophagus because of the malfunction of the IES produces chronic inflammation of its internal mucus layer. Likewise, the hypersecretion of chloride acid in the stomach and the bile reflux produces inflammation or even stomach ulcers.
How is GERD diagnosed?
The clinical symptoms are discussed during a medical visit. In the case of recurring symptoms in spite of treatment an endoscopic study of the superior digestive tract, is required to pinpoint a more specific diagnosis. Generally biopsies are necessary (taking tissue samples of the esophagical wall), LES, stomach or duodenum. After the endoscopy, other complementary studies are performed, e.g. esophageal contrast medium swallow, pH metry and manometry or impedance test.
What medications are prescribed for GERD?
There are a great variety of first generation medicines such as Famotidine, Cimetidine or Ranitidine, which act as antihistamines H2. After these were introduced, the family of the proton pumps inhibitors such as Omeprazole, Lanzoprazole, Pantoprazole or Esmoprazole and the use of gel, such as aluminum and magnesium, sucralfate, magaldrate or guaiazulene, followed. These medications are used by themselves or combined, depending on the diagnosis, to diminish acidity and cover the gastric mucus.
Does a surgical treatment for GERD exist?
After a specialized assessment, surgery may be indicated. It has to be pointed out that not all GERD and hiatal hernia patients are eligible for antireflux surgery. The most studied procedure in the long term is endoscopic Nissen funduplication. This consists of making a new valve by wrapping up the funds of the stomach around the esophagus to solve its mechanical deficiency.
GERD is very common among the general population and can greatly affect the quality of life. In many patients, dietary indications and posture may remedy some symptoms, but a large proportion needs medication to control the symptoms. Although the most frequent complaint is heartburn, the appearance of atypical symptoms requires specialized medical assessment and treatment.
Marco Antonio Gordillo Mörath MD is a gastrointestinal surgeon at Hidalgo 28, 152-5466 or 152-0430, emergency at 044-415-105-1234, e-mail: firstname.lastname@example.org