ACID REFLUX
The esophagus is a tube like structure approximately 10 inches long. It is made of tissue and muscle layers that expand and contract to propel food into the stomach . At the lower end of the esophagus, there is a circular ring of muscle that acts like a valve called the lower esophageal sphincter (LES). After swallowing, this valve relaxes to allow food to enter the stomach and then contracts to prevent the back-up of food and acid into the esophagus. Acid reflux occurs when the LES is weak, allowing stomach acid to wash back into the esophagus.
Acid reflux ( defined as at least once a week heartburn and/or acid regurgitation) is seen in 10 to 20 percent of people in the western world.
Symptoms
Heartburn / Regurgitation
Non-burning chest pain
Difficulty or painful swallowing
Hoarseness of voice
Persistent sore throat
Chronic cough
New onset asthma, or asthma only at night
Sense of a lump in the throat
Worsening dental disease
Recurrent pneumonia
Chronic sinusitis
Diagnosis
GERD is usually diagnosed based upon symptoms and the response to treatment with acid blockers.
Endoscopy is indicated in those with:
Longstanding acid reflux ( especially whites >50 yrs of age)
Difficulty or pain with swallowing (feeling that food gets “stuck”)
Unexplained weight loss
Bleeding (vomiting blood or dark-colored stools)
Other tests include ambulatory esophageal pH study ( directly measures esophageal acid exposure) and esophageal manometry ( measures the muscle contractility in esophagus)
Treatment
In people who have symptoms of reflux but no evidence of complications, a trial of treatment with lifestyle changes and medications, are often recommended. Available medications include antacids, histamine antagonists, proton pump inhibitors. Surgery – usually a Nissen fundoplication- is indicated in some patients.
COMMONLY USED DRUGS
H2 RECEPTOR ANTAGONISTS
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)
PROTON PUMP INHIBITORS
Omeprazole ( Prilosec )
Esomeprazole (Nexium)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)
Lansoprazole ( Prevacid)
For more information please see
www.gastro.org/public/digestinfo.html
www.niddk.nih.gov/health/digest/pubs/heartbrn/heartbrn.htm
http://www.acg.gi.org/acg-dev/patientinfo/frame_giproblems.html