Gastroesophageal reflux disease (GERD) is a disease caused by the reflux of stomach and duodenal contents into the esophagus, with heartburn and acid reflux being the typical symptoms. The incidence of GERD is increasing in both Eastern and Western countries, and it is one of the most common diseases seen by gastroenterologists.
The main pathogenesis of GERD is as follows.
1. weakening of anti-reflux mechanisms.
2. damaging effects of refluxes.
3, abnormal autonomic function.
4, psychological factors.
The lifestyles associated with GERD are.
1. eating too many, too fast, too full meals.
2, preference for stimulating foods such as coffee, strong tea, chocolate, onions, garlic, peppers, etc.
3, obesity, preference for high-fat foods.
4, preference for alcohol and tobacco.
5, taking some stimulant drugs such as non-steroidal anti-inflammatory drugs, anticholinergic drugs, tetracycline and other antibiotics.
6, irregular life staying up late, etc.
7, mental factors such as anxiety, anger, pain and other emotions.
GERD and sleep disorders are closely related.
Reflux during nighttime sleep is an important element of GERD-related symptoms. Reflux patterns during wakefulness and sleep are different, with delayed gastric emptying, slowed esophageal peristalsis, reduced swallowing and salivary secretion, and prolonged clearance of esophageal contents during sleep.
Studies clearly suggest that GERD is closely associated with many sleep disorders, such as reduced duration of sleep, difficulty falling asleep, awakening during sleep, poor sleep quality, and early awakening in the morning. A recent update on the mechanism of GERD effects on sleep by the activity change recording method revealed the presence of nociceptive sensitization of the esophagus to acid perfusion after sleep deprivation. This shows that the role between GERD and sleep disorders is bidirectional.
Gastroesophageal reflux treatment pathways.
Improving lifestyle (as described above in many ways) can reduce the triggers that promote GERD symptoms, with a special emphasis on avoiding late night meals and proper sleep position adjustment can significantly reduce nocturnal reflux.
In terms of treatment, the rational use of proton pump inhibitor (PPI) drugs can improve both nocturnal symptoms and subjective sleep parameters, but whether they have any effect on objective sleep parameters remains to be studied. For some patients with conventional doses of PPI drugs that are not effective in relieving nocturnal acid reflux and sleep disorders, the time point of PPI drugs can be adjusted, or a double dose of PPI drugs can be given, or an H2 receptor blocker can be added, or some other new drugs can be combined to better control nocturnal acid secretion.
Patients with GERD combined with sleep disorders can be treated for the underlying cause (nocturnal reflux) with the use of sleep-aiding drugs. The reason for this is that some patients have a combination of psycho-psychiatric factors involved in the development of GERD and sleep disorders, so the reasonable screening of such patients and the appropriate use of sleep aids can play a synergistic role in the overall treatment. In conclusion, GERD patients with sleep disorders have more severe gastroesophageal symptoms and poorer quality of life than GERD patients without sleep disorders, so both patients and clinicians should pay sufficient attention to these patients.