| Gerd Overview* |
| Written by James Black | |
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Gastroesophageal Reflux Disease, or GERD, is a disease of the esophagus, the tube connecting the throat to the stomach. When healthy people chew and swallow, a mixture of food and saliva leaves the mouth and travels through the throat and esophagus. At the bottom of the esophagus is a valve made of muscle, the LES or lower esophageal sphincter, which relaxes and contracts in response to swallowing. As the LES relaxes, food moves from the esophagus to the stomach. Then the LES contracts, preventing the contents of the stomach from leaking back in. The acids and bile salts in the stomach begin digesting the food, breaking it down into nutrients the body can absorb for energy.
Ordinarily, the LES relaxes only in response to swallowing. The relaxation lasts just a few seconds, enough time to allow food to pass through, and then immediately contracts. The opening between the esophagus and the stomach is also extremely narrow, allowing just enough room for the food to pass through and no more. Thus, access to the stomach is closed off most of the time, and other internal organs are protected from irritation and inflammation by stomach acids. In GERD, the LES does not work properly, and the digestion process is thrown off kilter as a result. The easiest way to understand GERD is to imagine the LES as a doorway between the stomach and the esophagus, which opens when the LES relaxes, and closes when it contracts. When the door is in good condition, it opens only in response to swallowing; it remains open only a few seconds, and it only opens a crack. In patients with GERD, the door opens too wide, for too long, and at the wrong times. A heady mixture of food, acids and bile salts, produced in the stomach during digestion, starts to flow back through the doorway into the esophagus, instead of staying in the stomach where it belongs or continuing its voyage into the lower intestine. This backward flow of stomach fluids into the esophagus is known as acid reflux. Unlike the stomach lining, which is thick, tough and designed to withstand strong chemicals, the esophagus is quite sensitive and lined with nerve endings. Acid reflux stimulates these nerves, which then transmit an alarm message up to the brain, causing the sensation of heartburn, the searing pain that we recognize as a symptom of GERD. Heartburn is a feeling that one's chest is on fire. It can also hit the neck, the back and the abdomen. Sometimes it feels sharp, like an endless needle prick. It is often confused with angina, the heart pain caused by a heart attack. However, it is not actually a sign that the heart is burning. Rather, it is the body's way of telling us that stomach acids are leaking into the esophagus. The stomach is at its most active right after meals, when it produces a lot of acid to aid in digestion. After a particularly large meal, the stomach contains more acid. As a result, acid reflux, and the accompanying sensation of heartburn, tends to occur after meals. Certain body positions can also intensify acid reflux and heartburn because of the effects of gravity. When a person is standing up, the esophagus is above the stomach, which makes acid reflux less likely because the acid has to travel upwards. If the stomach is above the esophagus, or next to it, instead of below -- for example, when lying down or bending over -- stomach acid can leak into the esophagus more easily. For this reason, GERD patients often wake up in the middle of the night with severe heartburn, unless they take care to sleep in an upright position. Prolonged and frequent heartburn is the most common symptom of GERD. However, some severe cases are associated with frequent nausea and vomiting instead. For this reason, patients who complain of chronic nausea and vomiting are usually tested for GERD. The acid reflux in GERD has other side effects which are more dangerous than heartburn, although not necessarily more painful. The most common is regurgitation. At the top of the esophagus is a muscle called the UES, or upper esophageal sphincter, which works in the same way as the LES and separates the esophagus from the throat. Most of the time, the wayward acids never reach the UES; they venture only as far as the lower esophagus, and are eventually pumped back into the stomach. When small quantities of acid reflux leak through the UES into the throat, GERD patients experience it as an acid taste in the mouth. In the most severe cases, however, the reflux is powerful enough to push large quantities of stomach fluids through the UES; it becomes a flood rather than a trickle. Lots of liquid, undigested food and acid are regurgitated. Patients with severe GERD in effect find themselves vomiting after every meal and at random times during the night. The damage wraught by GERD is not limited to heartburn, nausea, and regurgitation. Over the long term, untreated acid reflux is likely to damage the esophagus, causing esphagitis (chronic irritation and inflammation of the esophageal lining), ulcers (sores), and stricture (the narrowing of the esophagus as a result of accumulated scar tissue). There is also a higher risk of esophageal cancer. How, then, does one treat this insidious disease? There are some helpful home treatments. Over-the-counter antacids help to neutralize stomach acid, in this way reducing the symptoms -- heartburn, sour taste in the mouth, regurgitation -- and even preventing reflux. GERD patients benefit from eating small meals, which don't produce as much stomach acid as large feasts. They also eat several hours before bedtime, so that when it's time to lie down, the stomach is no longer full of acid. Finally, it is best to avoid tobacco, alcohol, and spicy or acidic foods which tend to increase stomach acidity. Medications and surgery for GERD are treated in greater depth in another article. *This article is based on the information at http://www.mayoclinic.com/health/gerd/, http://www.nlm.nih.gov/medlineplus/ency/article/000265.htm, http://www.webmd.com/heartburn-gerd/tc/gastroesophageal-reflux-disease-gerd-symptoms, http://www.gerd.com/, ttp://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/article.htm |
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