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GERD: A Common Medical Problem

By Salvador Quiroz

If you experience repeated bouts of heartburn, sour or acid-tasting fluid in your throat, difficulty swallowing (especially hard, dry, food stuffs like meat or toast), or chest pain, then you may be having the classic symptoms of a common health problem called Gastroesophageal Reflux Disease (GERD). The heartburn caused by GERD may strike after you eat a large meal or when you bend over or lie down.

When you eat, food travels from your mouth down the esophagus to your stomach. Along the way, food passes through a one-way valve called the lower esophageal sphincter (LES), which is the opening to your stomach. Normally, the LES opens when you swallow. It allows food to enter the stomach, then closes quickly. With GERD, the LES doesn’t work right. It allows food and stomach acid to wash back into the esophagus, a process called reflux.

As swallowed food travels through the esophagus to the stomach, this part of the digestive process usually runs smoothly. In the stomach, acids and enzymes continue the process of breaking down the food before it moves into the intestines.

But with GERD, the LES does not work well enough to hold foods, fluids, and gastric juices in the stomach. Escaping stomach acid irritates the esophagus. Sometimes, the top of the stomach slips through an enlarged hiatus and thus forms what is called a hiatal hernia. The hiatus is an opening in the diaphragm (a muscle that separates the chest from the abdomen and helps us breathe) for the esophagus to pass through. The presence of a hiatal hernia can make GERD worse. However, it is important to remember that you can have a hiatal hernia without having GERD.

Exposing sensitive tissue in the esophagus to stomach acid (which is hydrochloric acid) can lead to serious inflammation, ulcers, and scarring. People with severe GERD may have difficulty swallowing (called dysphagia) and often have the sensation that food is stuck in their throat.

When the exposure to stomach acids causes swelling and inflammation in the esophagus, the medical term is esophagitis. This can lead to pain, pressure behind the sternum, and burning in the chest and throat.

A sore anywhere in the lining of the esophagus is called an ulcer. This can produce pain and bleeding and make it hard to swallow.

When the inflammation and/or the ulcers in the lining of the esophagus heal, they sometimes leave scar tissue that narrows the tube. These are called strictures; they make it harder and harder to swallow some foods.

In the next article, I will write about the medical evaluation and treatment of GERD. As a parting thought, however, remember that chest pain is a cardinal symptom of GERD. This chest pain is sometimes very difficult to differentiate from chest pain caused by a heart attack. Patients with GERD think they are familiar with chest pains, so whenever this symptom appears, they run for their antacids. And even when the pain does not subside, they continue to blame GERD. Be careful with this attitude: you may be DEAD WRONG!

Dr Salvador Quiroz, Internal Medicine and Kidney Disease, Hospital H+, Graduated

from the Mayo Clinic. Tel: 152 2329


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