Gastroesophageal reflux disease: etiology, diagnosis, and treatment

Gastroesophageal Reflux Disease (GERD)

Etiology

Gastroesophageal reflux disease (GERD) can be caused by a number of different medical conditions. People suffering from obesity are more likely to develop GERD, and given the obesity epidemic in the United States and other western countries this explains why the prevalence of GERD approaches 20% in these countries. Pregnant women, smokers, diabetics, asthmatics, and anyone who suffers from slow digesting also have an increased risk of developing this disease.

Some people may suffer from genetic or medical conditions that predispose them to developing GERD. A hiatal hernia results when the upper portion of the stomach pushes up into the tube that connects the mouth to the stomach, the esophagus, and if the hernia is severe enough then GERD may develop. Schleroderma is a rare, progressive disease that causes the skin and other connective tissues to harden, which may interfere with the proper functioning of the diaphragm that connects the esophagus to the stomach. Too much stomach acid can result from the development of tumors in and around the pancreas, and cause GERD.

Causes

The diaphragm is a valve that connects the stomach to the esophagus and helps to prevent digesting food from flowing backwards. If anything interferes with the proper functioning of this valve, such as obesity, then stomach acid can leak into the esophagus and irritate this tissue. If this happens often enough, then the esophagus will eventually become eroded by the stomach acid and esophageal ulcers and breathing problems will develop.

Symptoms

The prototypical symptoms of GERD are heartburn, which is a burning sensation in the center of the chest. Another common symptom is regurgitation of stomach acid or stomach contents into the mouth or throat. The strongest predictors of GERD have been shown to be chest pain and nocturnal cough, although chest pain can result from a number of other causes and is therefore not very useful diagnostically. Other symptoms common to GERD include hoarseness, chronic cough, chronic bronchitis, and dental erosions.

Treatment

There are a number of over the counter medications that are used to treat GERD, including Maaloz, Mylanta, Gelusil, Rolaids, and Tums. These antacids provide instant relief, but cannot help reduce esophageal inflammation. H2-receptor antagonists, or blockers, provide slow-acting, long-term relief by reducing stomach acid production. Common H2-receptor antagonists include Tagamet HB (cimetidine), Pepcid AC (famotidine), Axid AR (nizatidine), and Zantac (ranitidine). Proton pump inhibitors also provide relief by inhibiting stomach acid production, and include Prevacid (lansoprazole) and Prilosec (omeprazole). Although all of these medications are can be obtained over-the-counter, but stronger doses can be obtained with a prescription. Other treatment options include corrective surgery or medications to strengthen the diaphragm.