What is gastroesophageal reflux disease?
Gastroesophageal reflux disease is the phenomenon of (periodic) backflow of stomach acid into the gullet (esophagus). Another name for the symptoms that may occur include heartburn.
Description
Although gastroesophageal reflux can also occur in healthy individuals, it can be problematic when complaints arise from or if damage occurs to the lining of the esophagus. The reason mostly lies in the fact that the closure at the bottom of the esophagus just above the stomach (LES, lower esophageal sphincter) is not working properly (more). (Although no real sphincter is present there should exist a functional occlusion). Also, a diaphragmatic hernia (diaphragmatic hernia) may underlie reflux. In people with intellectual disabilities is gastroesophageal reflux often; with an IQ below 50 or 52% are affected; If there are additional limitations are severe, this is 70% or even higher.
The consequence of frequent reflux can lead to inflammation of the esophagus (esophagitis), which sometimes left untreated can lead to scarring and narrowing (stenosis), and sometimes also to intestinal metaplasia of the lining of the lower part of the esophagus. If this occurs it is called a Barrett's esophagus. This latter situation can sometimes lead to an adenocarcinoma of the esophagus. In such patients is therefore an endoscopy frequently recommended in order to detect such an early degeneration. If reflux is suspected, a reflection can esophagus (endoscopy) are performed to see if there is damage caused by stomach acid to the esophagus. When suspicious abnormalities are often small pieces removed esophageal tissue at the esophageal mucous membrane (biopsy) in order to determine the degree if any change metaplasia of the esophagus and to detect malignancy. Sometimes, one performs an esophageal pressure measurement (manometry), often combined with a 24-hour acid measurement of the esophagus in which the amount of acid being measured comes into the esophagus and can be checked to see if these moments are associated with times during the measurement that there occur problems. It is important that this is done without acid-blocking drugs it may cause a distorted image. In a subset of patients with symptoms no abnormalities seen or measured during examinations.
Gastroesophageal reflux disease treatment
By far the largest part of the patients can be treated with drugs that stop the gastric acid production, such as proton pump inhibitors, and H2-antagonists, or binding the acid. Antacids (antacid) are recommended for mild symptoms, especially products with algeldraat and magnesium as active substances. Reflux complaints are very common: antacids all forms of medicines is one of the largest expenses in the Netherlands.
In severe cases of the disease can be a surgical procedure are applied, a so-called fundoplication (folds of the gastric fundus, the dome of the stomach). The classic method is the Nissen fundoplication, wherein by means of a common, open surgery, the dome is folded 360 degrees to the esophagus. There are several variations on this method, as claimed in the fundoplication toupee, wherein the dome is not at all to be folded around the esophagus, but only along the back. Today, this surgery is usually performed laparoscopically. Recent clinical studies have also been carried out with a method in which the entire operation is carried out through the mouth and the esophagus. This is done with a specialized device that enfolds from inside the stomach dome and at the same time adheres to the esophagus.
Fundoplication is a good treatment option for patients who are not helped by good acid-blocking medications. It is important that this operation is performed by a surgeon with lots of experience in this. By far the largest part of the patients, however, responds well to acid-blocking drugs, and, therefore, does not require surgery.
Babies
Infants may in the first year reflux occur when the oesophageal sphincter does not open at the right time. Especially in infants lying drinking can mean that the stomach contents to flow freely in and out of the esophagus. That certainly gives when drinking a painful irritation.
Gastroesophageal reflux disease symptoms
The best known symptoms are heartburn, pain behind the breastbone and swallowing problems. In some cases, there arise ulcers on the inflamed part of the esophagus, and these in turn lead to loss of blood. The blood passes through the stomach into the intestines and eventually ends up in the stool. Sometimes the bleeding is so bad that fresh blood is regurgitated. Other symptoms are a burning throat and cough.