Definition

     Acid reflux or GERD (Gastroesophageal Reflux Disease)  is a condition in which stomach acid frequently splashes into the esophagus. This can inflame and damage the lining of the esophagus although this occurs in a minority of patients.

Causes

• Weakening of the valve between the stomach and the esophagus

• Fried or fatty foods, chocolates, peppermint, alcohol and coffee

• Cigarette smoking

• Hiatal hernia

Symptoms

• Heartburn - Typically a tight, burning pain behind the breastbone that moves up towards the neck. The pain usually flares up after meals (especially large meals) and lasts for as long as two hours.

• Regurgitation - This occurs when acid travels all the way to your throat, leaving a sour, bitter taste.

• Nausea

• Frequent salivation

• Difficulty swallowing

• Feeling of a lump in the throat

Possible Complications

• Ulcers - An ulcer is simply a break in the lining of the esophagus. Occasionally, this may erode into the esophageal blood vessels and give rise to bleeding into the esophagus. Occasionally, the bleeding is severe and may require transfusions of blood and endoscopic (a procedure in which a tube is inserted through the mouth into the esophagus) or surgical treatment.

• Strictures - Ulcers of the esophagus heal with the formation of scars (fibrosis). Over time, the scar tissue shrinks and narrows the lumen (inner cavity) of the esophagus. This scarred narrowing is called a stricture.

• Barrette's esophagus - Long-standing and/or severe GERD causes changes in the cells that line the esophagus. These cells then become pre-cancerous, and finally cancerous. This condition is referred to as Barrett's esophagus.

• Cough and Asthma - Many nerves are in the lower esophagus. Some of these nerves are stimulated by the refluxed acid, and this stimulation provokes coughing

Dagnostic Tests

• Therapeutic trial - Symptoms and response to treatment

• Endoscopy - Visualization of the esophagus

• X-rays

• Biopsies

• Examination of the throat and larynx

• Esophageal acid testing

• Esophageal motility testing - This determines how well the muscles of the esophagus are working.

• Gastric emptying studies - These are studies that determine how well food empties from the stomach

• Acid perfusion test - The acid perfusion (Bernstein) test is used to determine if chest pain is caused by acid reflux

Treatment

• Lifestyle changes

• Antacids

• Histamine antagonists

• Proton pump inhibitors

• Pro-motility drugs

• Foam barriers

• Surgery

• Prevention of transient LES relaxation

Prevention

• Avoid foods that cause symptoms of digestive distress such as fatty foods, chocolate, caffeinated food and drinks, citrus fruit or juices, tomato-based products, alcohol, and spicy foods

• Eat small meals rather than large ones, and don't lie down within three hours of a meal

• If heartburn bothers you at night, try raising the head of the bed six inches, perhaps by sliding blocks of wood under the bedposts.

• Cut on drinking alcoholic beverages

• Smoking cessation