gastro ./ clinical gastroenterology

Gastro-oesophageal Reflux, Factors That Determine It And Treatments
By Groshan Fabiola
Gastro-oesophageal reflux is a condition that appears if the lower oesophageal sphincter is abnormally relaxed. Because of the abnormally relaxed oesophageal sphincter, stomach's acidic contents can reflux into the gullet. This fact can also provoke heartburn, and if this happens daily, you must contact your doctor in order to receive medical care and advices.

Repeated episodes of gastro-oesophageal reflux can cause oesophagitis, which is the inflammation of the inner lining of the oesophagus. Gastro-esophageal reflux oesophagitis usually comes with symptoms like a burning or a painful sensation in the upper abdomen or chest, that sometimes radiates to the back, some patients can have breathing difficulties and suffer from hoarseness, and also excess belching can appear.

It was observed that gastro-oesophageal reflux appears especially after eating a large or fatty meal, drinking alcohol, lying down, bending over or bending and lifting. Usually, symptoms occur rarely, but there are also cases when they appear weekly, or even daily.
It is also known that smoking makes the gastro-oesophageal reflux to become much worse.

Gastro-oesophageal reflux can have a great influence in our lifestyle, the quality of our life can become lower. This disease can provoke oesophagitis if you are exposed for a long time to refluxed acid, and also, if oesophagitis lasts for a long time, it will lead to complications. There can appear a scar-tissue that contracts and a narrowing will come in the affected part of the oesophagus. Of course, this is a grave situation, the patient will have great difficulties when we wants to swallow, or he will not be able to swallow at all. He will need immediately medical care, but fortunately, this complication is rare.

The oesophageal sphincter, which is the muscular ring situated near the diaphragm, at the lower end of the oesophagus is functioning as one-way valve. It has the role to prevent stomach contents from flowing upward. When the sphincter is not working properly, stomach acid will flow into the oesophagus. It is not known the exact cause of gastro-oesophageal reflux apparition, but there are a few conditions that surely contribute to this problem.

If the patient has an overweight problem, the excessive fat in the abdominal cavity makes the pressure inside it to increase. That determines the contents of the stomach to travel up into the gullet.
Hiatus hernia is also a problem that can

lead to gastro-oesophageal reflux apparition. The oesophagus remains open because the diaphragm is not closing the lower end, and stomach acid will enter into the oesophagus.
In pregnancy, the uterus increases in size, it presses the stomach ,and the possibility of the reflux to come grows.

You should avoid tobacco, some foods like peppermint, coffee, fruit juices, chocolate and alcohol, and also you must take in consideration that lying down makes the reflux tendency to increase.

Usually, the symptoms of gastro-oesophageal reflux are obvious, so no tests are needed, but the doctor can perform some tests if he has doubts. For example, he can perform a gastroscopy, or can measure the acidity in the lower end of the oesophagus during a 24-hour period. There exists another method too, used only in complicated cases, and that is called oesophageal manometry.

If you want to reduce the risk of developing reflux, you should stop smoking, drink less coffee and alcohol, avoid high-fat meals, and try to lose weight if it is necessary.
If you do not have frequent symptoms, you can treat with antacids and histamine antagonists, no medical attention being needed, but if symptoms are very unpleasant, and the heartburn is frequent, you must go to the doctor at once.The doctor will determine if there are necessary some tests, or if you need stronger medication.

Usually antacids successfully have effect in controlling the symptoms, but if antacid medication fails, the doctor will prescribe medicines called histamine H2 antagonists, and next , if it is needed, proton pump inhibitors. There exist also a small number of cases that require laparoscopical procedure, where the oesophageal sphincter is strengthened.

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