Our stomachs are filled with acid, which helps us digest our food. Believe it or not, stomach acid has the same acidity as the electrolyte in a battery. The stomach mucosa serves as a defense against stomach acid, while the esophagus is unable to defend itself against it. When stomach acid flows back into the esophagus, it produces a hot sensation that we call “heartburn”. Almost everyone gets heartburn occasionally, but if it occurs 2 or more days a week for at least 3 months, you may have gastroesophageal reflux disease (GERD). Acid reflux occurs when the lower esophageal sphincter, which divides the esophagus from the stomach, does not close properly, causing acid to flow back into the esophagus.
Gastroesophageal reflux disease (GERD) is a chronic condition that can lead to more serious illnesses. However, GERD is treatable. In this section, you will learn about the causes and common symptoms of GERD, a very common disease.
GERD and the digestive system
Before understanding the causes of GERD, it is necessary to understand the digestive system. The upper gastrointestinal tract is composed of the following main parts.
1, oral cavity
2.Pharynx (the space at the back of the mouth)
3, esophagus (the tube connecting the pharynx to the stomach)
4. Stomach and duodenum (small intestine)
The esophagus connects the mouth to the stomach. A circular muscle called the lower esophageal sphincter (LES) is wrapped around the connection between the esophagus and the stomach. Normally, when we are not eating, the lower esophageal sphincter closes to isolate the stomach from the esophagus; when we are eating, the muscle relaxes and the lower esophageal sphincter opens, allowing food to enter the stomach. Later, the lower esophageal sphincter contracts again to stop the reflux of food from the stomach into the esophagus. The lower esophageal sphincter plays an important role in the digestive process. The stomach produces stomach acid to help digest food. The stomach has a special mucosal layer that prevents damage from stomach acid, while the esophagus does not have this protective layer and is therefore more vulnerable to damage from stomach acid.
When you have GERD, the lower esophageal sphincter opens more frequently or at the wrong time, causing acid to flow back into the esophagus, which can be very painful. If it persists for a long time, part of the esophagus may erode, called erosive esophagitis, which can cause more serious problems such as crusting, bleeding and ulcers. Chronic GERD can also lead to a condition called Barrett’s esophagus. In Barrett’s esophagus, abnormal changes in the esophageal mucosa occur, and patients with Barrett’s esophagus are at increased risk of developing esophageal cancer.
What can promote acid reflux?
Factors that contribute to acid reflux include
1. certain foods or beverages
2. Smoking
3. Being overweight
4.Eating too much
5.Bending after eating
6.Lying down within 3 hours after meal
What does the treatment of GERD include?
1.General treatment
Lifestyle changes should be used as the basic measure of treatment. Elevating the head of the bed by 15-20cm is a simple but effective way to use gravity to enhance acid clearance during sleep and reduce nocturnal reflux. Foods such as fat, chocolate, tea and coffee can lower LES pressure and appropriate control is advisable. Tobacco and alcohol can weaken the acid scavenging ability of the esophagus, reduce the LES pressure and weaken the protective function of the esophageal epithelium, so GERD patients should quit smoking and alcohol. Avoiding a full stomach 3h before bedtime can also reduce nocturnal reflux. 25% of patients can have their symptoms improved after changing the above habits.
2.Medication
If the symptoms of reflux cannot be improved by changing the lifestyle, systematic medication should be started. The purpose of treatment is to reduce reflux, relieve symptoms, reduce the mucosal damage caused by reflux substances, enhance the anti-reflux defense function of the esophageal mucosa, to cure esophagitis, prevent recurrence, and prevent and treat important complications.
Commonly used drugs include: proton pump inhibitors, prokinetic drugs, mucosal protective agents and other drug combination therapy, standardized course of treatment, and gradually transition to maintenance treatment.