Gastroesophageal Reflux Disease

What is the gastroesophageal reflux disease?

The gastroesophageal reflux disease is the passage of stomach contents into the esophagus.
This may happen physiologically in small quantities. However, its duration and frequency of
the acidic stomach juices in touch with the esophagus may generate symptoms or other
complications.

Why does the gastroesophageal reflux disease occur?

There are various mechanisms that together form part of the so-called ‘Anti-reflux barrier’.
When one or more of these mechanisms are altered, the gastroesophageal reflux disease can
occur.

The lower esophageal sphincter (LES) is a structure that is located in the last part of the
esophagus and is part of the anti-reflux barrier. This functions as a type of ‘valve’ that prevents
the passage of stomach contents into the esophagus.

Saliva helps to neutralize the stomach acid, that is why if the production of saliva reduces it
may influence on the appearance of reflux. Among others causes, the increase of intra-
abdominal pressure seen in obesity and pregnancy are part of the reflux mechanism.

Which are the symptoms of the gastroesophageal reflux disease?

Typical symptoms of reflux are an acid taste in the mouth or heartburn or the sensation of
liquid rising to the mouth (regurgitation). Another possible symptom, after excluding cardiac
causes, is chest pain. Other symptoms associated are cough and hoarseness, when coexisting
with typical symptoms of reflux or a study that attests to its association.

How is the diagnosis of reflux done?

The diagnosis has to be done by a doctor. The patient’s past medical record and their
symptoms are fundamental for a presumptuous diagnosis.

The doctor can request complementary tests if deemed necessary like an upper endoscopy
which will allow the categorization of the disease based on the presence of laceration on the
esophagus (fundamentally inflammation) and reflux tests like the ambulatory acid (pH) test
and the esophageal impedance test.

How is the treatment for reflux like?

Hygiene and dietetic measures can be recommended even though the only ones that were
scientifically proven are the elevation the head of the bed (this was observed only in patients
with nocturnal symptoms) and losing weight. In regards with a modification in the diet, this has
to be recommended individually depending on the patient.

Proton pump inhibitors are more appropriate drugs to manage this disease. Among this group
are: omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole or dexlansoprazole.
These drugs showed greater effectiveness relieving the symptoms, curing the esophageal
mucus and as a remedy for complications.

The treatment can be done in different ways. The medication, its dosage and administration
period will be decided by the treating doctor: from starting with high dosages and gradually
reducing them or starting with low dosages and gradually increasing them; a prolonged or
short treatment can be indicated depending on the reflux’s category.