GASTROESOPHAGEAL REFLUX DISEASE (GERD)

WHAT IS GERD?
   Gastroesophageal reflux disease (GERD) is a chronic digestive disease. It is a condition in which the acidified liquid content of the stomach backs up or flows back into the food pipe (esophagus) and even up to the throat. The esophagus is the tube stretching from the throat to the stomach. Not just adults are affected; even infants and children can have GERD.

CAUSES OF GERD
  After each meal the stomach produces hydrochloric acid to aid in the digestion of food. The inner lining of the stomach and cells lining the stomach resists corrosion by stomach acid and also secrete large amounts of protective mucus. However, the lining of the esophagus does not share these resistant features and therefore, stomach acid can damage it. Normally, when we swallow, the lower esophageal sphincter which is a  circular band of muscle around the bottom part of the esophagus at the entrance to the stomach, relaxes to allow food and liquid to flow down into the stomach. It then tightens to prevent flow in the opposite direction. However, if the sphincter doesn't close all the way, opens too often or relaxes between swallows, the hydrochloric acid produced by the stomach can move up into the esophagus causing symptoms such as frequent heartburn. This constant backwash (reflux) of acid can irritate and inflame the lining of the esophagus thereby, resulting in Gastroesophageal reflux disease (GERD).

SYMPTOMS OF GERD
   Symptoms of GERD include:
- Heatburn
- Bloody or black stools or bloody vomiting
- Feeling of tightness in the throat
- Regurgitation of food or sour liquid
- Bloating
- Difficulty swallowing (Dysphagia)
- Bitter taste in mouth
- Dry cough
- Chronic sore throat
- Chest pain
- Weight loss for no known reason
- Wheezing
- Nausea
  Seek immediate medical attention if you experience these symptoms.

RISK FACTORS OF GERD
   Conditions that can increase your risk of GERD include:
- Pregnancy
- Being overweight or obese
- Smoking
- Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications.
- Dry mouth
- Eating heavy meals
- Asthma
- Eating certain foods, such as citrus, tomato, mint, garlic, onions, or spicy and fatty foods.
- Diabetes
- Snacking close to bedtime.
- Connective tissue disorders, such as scleroderma.
- Drinking alcohol, carbonated drinks, coffee, or tea.

COMPLICATIONS
- Cough and asthma.
- Laryngeal and throat inflammation.
- Narrowing of the esophagus or esophageal stricture.
- An open sore in the esophagus or esophageal ulcer.
- Precancerous changes to the esophagus  or Barrett's esophagus.
- Inflammation and infection of the lungs .

TREATMENT
1. Life-style changes
2. Diet
3. Over-the- counter (OTC) drugs such as antacids and H2-blockers; prescription drugs such as coating agents, promotility agents and proton pump inhibitors that controls acid by neutralizing acid, reducing acid production, blocking acid production and healing the esophagus. These medications are generally well-tolerated, but long- term use may increase risk of bone fracture and vitamin B-12 deficiency.
4. Surgery- Doctors may recommend surgery when medications aren't helpful or to avoid long-term medication use.

PREVENTION
GERD can be prevented by:
- Avoiding alcohol
- Abstinence from smoking
- Limiting fatty foods and other food triggers
- Maintaining a healthy body weight
- Avoiding large meals within 3 hours of bedtime.