As a child, boys may have the ability to lean on the boom “upside down”, but also heard them innocently send back: “eat into the rice will not flow out of the mouth ah?” The kind elders always laugh and shake their heads. But there does exist the phenomenon of food eaten returning from the stomach to the esophagus, which is called gastroesophageal reflux. In actual life, normal people burp and regurgitate after a full meal, and babies spill milk after drinking milk, etc. These are all phenomena of gastroesophageal reflux, but they are occasional or temporary phenomena, not diseases.
Under normal circumstances, there is a section of the lower esophageal sphincter in the connection area between the lower esophagus and the cardia, and this “gate” keeps the food that people eat from their mouths even when they are in an inverted position. However, if the “gate” malfunctions, it is easier for things in the stomach to reflux upward into the esophagus, resulting in various abnormal pathological reactions or injuries, forming GERD. Gastroesophageal reflux exists in 10% to 20% of the general population, and only some of them develop GERD.
There are many people who have GERD, and people over 40 years old are especially prone to it. As the pace of life and work increases and stress increases, the number of people with GERD has also increased significantly. The disease can be long lasting and prone to recurrence.
What are the conditions that make people susceptible to GERD?
The “gate” between the lower esophagus and the cardia of the esophagus keeps food from refluxing, but if for some reason the esophagus cannot maintain sufficient pressure, or if the pressure in the stomach is greater than the pressure in the esophagus, the contents of the stomach will enter the esophagus, making it easier to get GERD. For example, taking some drugs, smoking and other external reasons will have an impact on the function of the esophagus; the elderly esophageal wall muscle relaxation, elasticity is reduced, the lower part of the esophagus and the esophageal cardia connection area “gate” role “failure”, also more likely to occur GERD.
For example, problems with gastrointestinal function, poor digestion of food, too much gas to make the pressure in the stomach is too high; growing fetus in the abdomen of pregnant women, a disease that generates too much ascites in the abdominal cavity, excessive abdominal exertion, etc. will cause increased pressure in the abdominal cavity, pushing to make the stomach pressure higher. These conditions are more likely to occur in GERD.
What are the serious consequences of reflux esophagitis?
It causes esophageal stricture. This is because the erosion of the esophageal mucosa causes scarring and contracture of the scarred area, resulting in narrowing of the lumen of the esophagus. In the case of esophageal stricture, the patient may have difficulty swallowing, which may start intermittently and may become more pronounced as the disease progresses.
When erosion of the esophageal mucosa damages the walls of the blood vessels, it can cause bleeding. When the bleeding is heavy, the patient may vomit blood.
Barrett’s esophagus is recognized as a precancerous lesion, so these patients are at risk of developing esophageal cancer. barrett’s esophagus is also considered a comorbid condition of GERD.
What is the main basis for doctors to diagnose GERD?
To diagnose GERD and reflux esophagitis, the doctor may require certain tests depending on the patient’s condition. Patients with less severe GERD can be diagnosed with typical symptoms such as heartburn, acid reflux and chest pain, and generally do not require much testing.
Empirical PPI treatment is a simple and easy way to make a diagnosis, i.e., the doctor has the patient take oral PPI preparations (i.e., Loxac, Nexium, Polite, etc.) for 2 weeks, and if the patient has relief of symptoms, the initial diagnosis of GERD can be made.
For patients with GERD, gastroscopy is necessary because it is the only way to determine if the patient has GERD and also to determine the extent of the lesion.
If the patient is determined to have reflux esophagitis through gastroscopy, the doctor will also ask the patient to undergo a pathological examination, in which a small piece of esophageal mucosa is removed through the gastroscope for examination to see if precancerous lesions have occurred.
How do doctors treat GERD?
Medication, there are 4 types of therapeutic drugs, whose effects are: to reduce gastroesophageal reflux; to reduce the acidity of the reflux to reduce the damage to the esophagus; to increase the peristalsis of the esophagus to speed up the removal of the reflux; and to protect the esophageal mucosa.
Persistent GERD that does not respond to medication can be treated surgically or with gastroscopic intervention.
How to cooperate with the doctor in the treatment of GERD?
GERD and reflux esophagitis is a chronic disease that is prone to recurrence and requires patients to adhere to a longer treatment period. The length of treatment varies depending on the medication used and the esophageal lesion. Generally, a course of treatment is appropriate for 2 months, and may be followed by several consecutive courses or even lifelong treatment. Patients should pay attention to the following points during treatment.
There are more types of drugs for treating GERD, and the method of taking them is relatively complicated, so they must be taken correctly according to the doctor’s instructions. Reflux esophagitis mostly recurs within the first year of stopping treatment, so even after the symptoms have disappeared and the esophagitis has healed, the doctor will make arrangements to take some medication in small doses for at least 6 months, usually for 1 year, and some people even need to take the medication for life. Those who are found to have precancerous esophageal adenocarcinoma after gastroscopy and pathological examination should be reviewed regularly.