Thursday, June 2, 2011

What is GERD AND What Causes GERD?


What Is GERD?

Edited by Guy Slowik MD FRCS. Last updated on January 27th 2011
GERD stands for Gastro Esophageal Reflux Disease. "Gastro" refers to the stomach. Esophageal refers to the esophagus , the tube that carries food from the mouth to the stomach. Reflux means to back-up or flow backwards. GERD is a condition in which acid, bile and partially-digested food in the stomach back up into the esophagus.
  • Partially digested food contains a strong acid. It also contains powerful enzymes that break down food. When acid and enzymes come into contact with the esophagus, they cause irritation, inflammation, pain, and other symptoms.
  • The stomach lining has a special protective layer that protects the stomach from acid attack. However, this protective layer does not exist in the esophagus, making it vulnerable to damage from stomach acid and digestive enzymes.
  • Many people think that heartburn (or acid indigestion) is a separate disease. It actually is one symptom of GERD. Heartburn is an unpleasant burning sensation behind the breastbone that usually occurs after a meal.
  • Most individuals with GERD also have hiatal hernias , which make it easier for stomach contents to reflux into the esophagus. Ahiatal hernia occurs when part of the stomach bulges into the chest cavity through an opening in the diaphragm (hiatus). The diaphragm is a sheet of muscle that separates the stomach cavity from the chest cavity.


GERD occurs when a muscle at the lower end of the esophagus does not work properly. The muscle is called the lower esophageal sphincter (LES). Sphincters are ring-like bands of muscle that contract, or squeeze together, to close off body passageways. The body has many sphincters. Perhaps the most familiar is the anal sphincter, which seals off the rectum between bowel movements.
  • The LES acts like a one-way valve that closes off the esophagus. It allows food to travel freely downward into the stomach. But it also seals off the stomach, preventing partially digested food from refluxing, or passing back up, through the esophagus.
  • Normally, the LES closes immediately after a person swallows food, keeping irritating stomach acid and digestive enzymes out of the esophagus.
  • In individuals with GERD, the LES may not close in a normal way or relaxes inappropriately between swallows. Stomach juices and partially digested food may flow back up and burn the lower esophagus. The result is heartburn and other symptoms ofGERD.

GERD and Hiatal Hernia

A hiatal hernia occurs when part of the upper stomach bulges, or herniates, into the chest cavity. It bulges through a natural opening in the diaphragm where the esophagus enters the abdominal cavity. A hiatal hernia is named for the opening, which is called the esophageal hiatus. Some people are born with a hiatal hernia. Others develop one later in life.
A hiatal hernia can contribute to GERD in two ways:
  • The diaphragm muscles normally wrap around the lower esophageal sphincter (LES). These muscles contract with the LES, adding their force to help close off the esophagus and prevent reflux. When a hiatal hernia occurs, the LES slides up into the chest cavity. But since the diaphragm remains in the same place, it can no longer add its muscle power to the LES. As a result, the LES does not contract completely.
  • The esophagus normally connects to the stomach at a sharp angle. Tissue from the esophagus and stomach at this point form a bend that acts like a second stomach valve. When the stomach is full, the bend can help seal off the stomach and prevent reflux. When a hiatal hernia pulls the stomach into the chest, the bend becomes less sharp and is less effective as a valve.

  • What Are The Symptoms Of GERD?

    Edited by Guy Slowik MD FRCS. Last updated on January 27th 2011
    Heartburn is the most common symptom of GERD. It feels like a burning chest pain right behind the breastbone. Pain may move upward toward the throat. It often is worse after meals. Bending over or lying down also may make heartburn worse. Standing up may bring relief. Heartburn often occurs after going to bed at night.
    Other GERD symptoms include:
    1. Burping-up, or regurgitation, of sour-tasting, acidy material into the mouth.
    2. Difficult or painful swallowing.
    3. Sore throat, hoarseness, and/or cough.
    4. Wheezing in people with asthma.
    GERD also occurs in young children who may have the same symptoms as adults but cannot describe them. The only noticeable symptoms in infants and children may be vomiting, coughing, wheezing or other respiratory problems, and failure to gain weight normally.

    What Is The Treatment For A Hiatal Hernia?

    Edited by Guy Slowik MD FRCS. Last updated on January 27th 2011
    Treatment depends on the kind of hiatal hernia. A hiatal hernia can be either para-esophageal or sliding.

    Sliding Hernias

    • Sliding hiatal hernias are the most common. They occur when part of the stomach bulges through the diaphragm and into the chest cavity when a person swallows food. The hernia actually slides back and forth between the abdominal and chest cavities.
    • Sliding hiatal hernias usually do not cause symptoms and do not require treatment.
    • When symptoms do occur, their treatment is the same as for GERD.

    Para-esophageal Hernias

    • Para-esophageal hernias are the least common. They occur when part of the stomach bulges into the chest cavity and stays there all the time. A large para-esophageal hernia may make it difficult for food to pass normally into the stomach. In addition, ulcers may form in the herniated part of the stomach.
    • Surgery is the treatment for large para-esophageal hernias. During the operation, the surgeon moves the herniated area of stomach back into the abdominal cavity. He then tightens the esophageal hiatus, making it smaller so the stomach can no longer bulge through. Finally, he makes sure that the esophagus is firmly attached to the diaphragm.

    • How Is GERD Treated?

      Edited by Guy Slowik MD FRCS. Last updated on January 27th 2011
      GERD can be treated with lifestyle changes, medication, or surgery. Many people with GERD improve a great deal by eliminating factors in their daily lives that contribute to reflux. Lifestyle changes often are used in combination with non-prescription or prescription drugs. In the rare cases, however, when those measures fail, surgery can provide relief.

      Lifestyle Changes

      GERD may occur less often or disappear after individuals make simple changes in daily life. Changes involve eliminating factors that cause reflux.
      • Some common foods and beverages increase the risk of reflux by relaxing the lower esophageal sphincter (LES). Reflux triggers include alcoholic beverages, chocolate, carbonated beverages, coffee, tea, soft drinks containing caffeine, spicy foods, and fatty foods.
      • Cigarettes contain chemicals that also relax the LES as they pass from the lungs into the blood.
      • Obesity increases abdominal pressure, forcing stomach contents past the LES. In some cases, GERD symptoms disappear completely after an overweight person looses 10-15 pounds.
      • Sleeping habits can trigger GERD. Lying down flat presses the stomach's contents against the LES. When a person goes to bed within two-three hours of heavy eating or drinking, a meal which includes GERD-triggering foods - spicy food, wine, coffee, and a chocolate desert, for instance - makes matters much worse.
      • Clothing that fits tightly around the abdomen squeezes the stomach. It can force food up against the LES. Problem clothing includes tight-fitting belts and slenderizing undergarments.

      • Medication

        Medications can be used when lifestyle changes alone do not bring adequate relief. Many people with heartburn and GERD self-treat their symptoms with non-prescription drugs. Antacids and other products can ease the immediate symptoms. But they seldom bring complete relief. Several prescription drugs can be more effective. Doctors use three groups of medications to treat GERD.
        1. Prokinetic medications work by increasing the pressure of the lower esophageal sphincter (LES) . By causing the LES to contract with greater force, they reduce the chances that food will reflux into the esophagus. These medications include Propulsid(cisapride), Reglan (metoclopramide), and Bethanacol(urecholine). Propulsid is being removed from the market because of evidence that it can cause serious disturbances in heart rhythm. People taking Propulsid should contact their physician about an alternative medicine.
        2. Proton pump inhibitors suppress almost all acid production in the stomach. These medications include Prilosec (omeprazole),Prevacid (lansoprazole), Aciphex (rabeprazole), Protonix(pantoprazole), and Nexium (esomeprazole). Although they do not prevent GERD, these drugs allow inflammation and other damage in the esophagus to heal by reducing the acidity of refluxed stomach contents.
        3. Histamine blockers partially suppress the production of stomach acid by blocking the action of histamine on cells in the stomach lining. Histamine is a protein that signals stomach cells to make hydrochloric acid. These drugs help inflammation in the esophagus to heal by reducing the acid that causes it. Some are available as non-prescription medicines in a lower strength. Examples of non-prescription histamine blockers include Zantac (ranitidine),Tagamet (cimetidine), and Pepcid (famotidine).

        4. Surgery

          When severe symptoms of GERD persist after lifestyle changes and drug treatment, surgery may provide relief. In the past, surgical treatment of GERD required a large abdominal incision and meant a long period of recovery. The use of a laparoscope, a thin viewing tube, and the development of laparoscopic surgery methods, however, has made surgery for GERD easier on patients. Laparoscopic surgery, a minimally invasive procedure, is done through small incisions. Patients can leave the hospital quicker, and recover faster.
          For further information about laparoscopy, go to Laparoscopy.
          • Laparoscopic anti-reflux surgery is the most common form of surgery for GERD. The operation is sometimes called Laparoscopic Nissen Fundoplication. It involves strengthening the lower esophageal sphincter (LES) by wrapping part of the upper stomach around the sphincter and lower esophagus. The flap of stomach fits around the esophagus much like a hot dog bun fits around a hot dog. It reinforces the LES, helping the sphincter to close more strongly.
          • In some cases, the conventional "open" surgery (called Nissen Fundoplication) which requires a larger abdominal incision, may be needed. It is used mainly when surgeons are not able to see abdominal structures through the laparoscope because of scar tissue from past operations or other complications.
          • If a hiatal hernia also is present, it usually will be repaired during anti-reflux surgery.
      • http://ehealthmd.com/library/heartburn/HB_whatis.html



Warm Regard, Sara Pandian
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