Gastroesophageal Reflux refers to the return of some of the contents of the stomach into the esophagus (the duct connecting the mouth to the stomach). The stomach produces gastric juices, very acid substances that help digest food. The wall of the esophagus is not designed to resist the acidity of the contents of the stomach. Reflux, therefore, causes inflammation of the esophagus, which results in sensations of burning and irritation. Over time, there’s a lesion to the esophagus. Note that a low-level of reflux is normal and inconsequential and referred to as physiological (normal) reflux.
Gastroesophageal Reflux: Causes
In most patients, reflux is due to a malfunction of the lower esophageal sphincter. This sphincter is a muscular ring located at the junction of the esophagus and the stomach. Typically it is tight, preventing the contents of the stomach from ascending to the esophagus, opening only to let ingested food pass and thus acting as a protective valve. In the event of reflux, the sphincter opens at bad times and lets up the gastric juices of the stomach. People who suffer from reflux often have acid regurgitation after a meal or at night. This phenomenon of regurgitation is quite common in infants because its sphincter is immature.
Gastroesophageal reflux may also be linked to a hiatal hernia. In this case, the upper part of the stomach (situated at the junction of the esophagus) “ascends” with the esophagus into the rib cage through the orifice of the diaphragm (the Hiatal orifice). However, hiatal hernia and gastroesophageal reflux are not synonymous, and the hiatal hernia is not always associated with reflux.
Gastroesophageal Reflux: Complications
Prolonged exposure of the esophagus to acidic gastric substances can cause:
- Inflammation (esophagitis), with lesions of the esophagus more or less hollow responsible for ulcers (or sores) on the wall of the esophagus, which graded in 4 stages according to their number, depth, and extent;
This inflammation or ulcer may cause hemorrhage. - A narrowing of the diameter of the esophagus (peptic stenosis), which causes difficulty in swallowing and pain during swallowing
- A Barrett’s esophagus. This involves the replacement of cells in the esophagus by cells that typically develop in the intestine. This replacement is due to repeated “attacks” of gastric acid in the esophagus.
It is not accompanied by any particular symptoms but detected by endoscopy because the normal gray-pink color of the esophagus tissues takes on a flaming pink-salmon color. Barrett’s esophagus exposes him to the risk of ulcer and, above all, esophageal cancer.
Gastroesophageal Reflux can also cause complications at a distance:
- A chronic cough
- A hoarse voice
- A laryngospasm
- Cancer of the esophagus or larynx in the case of uncontrolled and unmonitored reflux
Gastroesophageal Reflux: Main symptoms
The main symptoms of Gastroesophageal Reflux appear especially after meals or in lengthened position:
- A “burning” feeling behind the sternum. Doctors talk about heartburn.
- Acid regurgitations, which give a bitter taste in the mouth
Reflux can also result in less frequent and more general symptoms:
- A hoarse voice, especially in the morning
- Chronic sore throat
- Asthma occurring at night and unrelated to an allergy
- A chronic cough or frequent hiccups
- Nausea
- Persistent bad breath
- Dental problems (loss of teeth enamel)
In infants, the symptoms of reflux are as follows:
- Excessive regurgitation and/or vomiting
- Pain, refusal to drink, crying
- Stunting and anemia in severe cases
- Episodes of apnea (rare)
Alarming symptoms lead to seeing a doctor immediately, as they may indicate a complication or other illness:
- Difficulty in swallowing.
- Recurrent vomiting
- Pain during swallowing
- A cough, asthmatic breathing
- A repeated need to rinse your throat
- Stomach upset
- Abnormal weight loss
- The appearance of blood in the sputum (expectorations), or blood in vomiting or the stool (black stool)
- Lack of improvement with medical treatment of 4 to 8 weeks.
- Anemia (in the case of large blood loss)
Gastroesophageal Reflux: People at Risk
- People who have a hiatal hernia (see above).
- Pregnant women, during the last months of pregnancy. The fetus exerts additional pressure on the stomach; the reflux is, in this case, only temporary.
- Obese or Overweight
- People aged 50 and over. With age, some individuals have a less effective esophageal sphincter, which can cause gastroesophageal reflux.
- People with scleroderma.
- People who run or often dive experience reflux during exercise.
Risk factors
Smoking (cigarette, cigar, pipe) increases the risk of gastroesophageal reflux. Smoking cessation, with the adoption of other lifestyle measures, can help alleviate the symptoms.
Gastroesophageal Reflux: Medications
Whether you are taking a medication for gastroesophageal reflux or not, it is essential to put in place the measures of prevention of the recurrences listed above and to modify certain habits of life. If this is not enough, people with regular reflux can get a simple and effective treatment to relieve their symptoms. However, as reflux is a chronic disease, it is sometimes necessary to continue taking medication over the long-term.
Several drugs administered to decrease gastric acidity:
- Antacids (Maalox®, Rocgel®, Xolaam® Rolaids®, Tums®) which neutralize gastric acid, are taken in case of symptoms. If you must use over-the-counter antacids for more than three weeks, it is necessary to consult your doctor.
- The H2 antagonists (Tagamet®, Raniplex®, Nizaxid®, Azantac®, Axid®, Pepcid®, Zantac®) reduce acid production by the stomach. H2 antagonists offered over-the-counter and are usually sufficient to treat mild cases, in conjunction with the prevention advice described above. That said, it is not desirable to take antacids for long periods, as they may interfere with the absorption of certain nutrients.
- Proton pump inhibitors (PPIs): If antacids or over-the-counter H2 antagonists do not completely alleviate the symptoms, return to your doctor. It will prescribe IPPs (Inexium ® Lanzor ®, Pariet ®, Losec ®, Nexium ®, Pantoloc ®, Prevacid ®, or their generics).
These are the most effective medications to treat reflux, but they can cause side effects if not taken properly. It is therefore essential to follow the recommendations of your doctor. Depending on the age of the disorders, an endoscopy, prescribed. In addition, as a supplement to medication, the doctor sometimes recommends that certain foods be excluded or restricted.
Gastroesophageal Reflux: to remember
30% to 40% of people with gastroesophageal reflux disease continue to have signs of reflux or feel embarrassed despite proper treatment. The majority of reflux symptoms resistant to PPIs are secondary to “no pathological reflux.”
Good to know: Some specialists sometimes recommend a vitamin supplement to people who are under anti-reflux medication to avoid certain deficiencies. According to some, a deficiency of vitamin B12, vitamin C, magnesium, possibly iron, can occur. Indeed, anti-reflux drugs can decrease the absorption of nutrients and certain medications. If you are taking any other medicines, consult your doctor or pharmacist.
Gastroesophageal Reflux: Surgical treatment
If medications fail, surgery to treat gastroesophageal reflux is possible. However, it is reserved for people with severe complications such as severe nonresponsive oesophagitis associated with a large Hiatal Hernia. It is rarely practiced.
