GERD is the name given to the disease caused by gastroesophageal reflux known as GER, which refers to the movement of stomach contents that travels through the esophagus. This disease produces discomfort that affects the quality of life and in some cases complications arise in its patients.
When consuming solid food or ingesting some liquid, these pass through the esophagus and are taken to the stomach and there, together with the gastric juice (stomach content), they are transformed into a mixture known particularly as hydrochloric acid. When food reaches the stomach and is processed, it is transformed into a kind of porridge, due to the work of gastric juice and other gastric contractions that work up to hours to complete the transformation of food and thus later gastric emptying can occur ( taken to the duodenum).
As for the circulation of food from the passage through the esophagus to the stomach, they are controlled by an internal esophageal sphincter that works as a muscular valve located at the esophagogastric junction that, when opened, allows food to pass into the stomach and then closes to prevent stomach contents back up into the esophagus.
In patients with GERD, this inner esophageal sphincter usually does not work well, most patients have a hypotonic sphincter (weak sphincter) that remains open most of the time or for long periods of time causing food to flow back into the esophagus.
What is GERD?
GERD is a disease caused by gastroesophageal reflux (GER), in other words, it is when stomach contents leave the stomach and back into the esophagus. When the patient usually has this type of situation commonly, then he presents GERD which decreases the quality of life and runs the risk of suffering organic complications. As for the occasional gastroesophageal reflux that occurs during the day, it can be considered as something totally normal.
When gastroesophageal reflux occurs frequently, it can be considered as GERD, it also has a lot to do with the body position at the time it occurs, one of the most frequent forms is when lying down, since the content that is in the stomach enters in contact with the mucosa, which is what protects the stomach from the acids it contains.
This mucosa mentioned above is affected when reflux occurs, since the hydrochloric acid of the gastric juice when coming into contact with it causes pain in the person. It is necessary to take into account the body position in which the person is, since if they are standing, then gastric acids go down, on the other hand, if the person is lying down, it is more difficult to prevent food from leaving the esophagus.
In case everything is presented normally, food passes from the esophagus to the stomach through the lower esophageal sphincter (muscular valve) that closes once the passage of food is finished and thus prevents the stomach content from leaving again towards the esophagus.
When a person has a hypotonic sphincter (weak sphincter) they are prone to GERD, since due to this muscular deficiency, the sphincter lets out the stomach contents into the esophagus because it remains open for long periods of time, which are also variable. .
Origins of GERD
As for its origin, it cannot be precisely described because it can arise from various factors, although what can be said is that it is considered as a motor disease. Today it has not been possible to identify all the factors involved that give rise to this condition, but it has been suggested that one of the most important factors that influence this disease is the malfunction of the inner esophageal sphincter (hypotonic sphincter) .
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In addition, this gastroesophageal reflux disease (GERD) has been associated with another, which occurs in the larynx and consists of having the sensation of having a ball or balloon in the larynx. We can also mention odynophagia, which although it is usually something particular, implies the presence of a severe erosive esophagitis or an esophageal ulcer. They are often known about nausea presented in some patients.
Characteristics of GERD
This disease occurs frequently in more developed countries, it is a fairly common disease, which has an affected population of at least 7.7%. Regarding gender, there is a higher incidence in the case of men who have this disease compared to women. But in relation to GER in the respiratory tract, both men and women have the same proportion of occurrence.
Causes of GERD
Although there are many factors that cause this pathology, these days the investigations regarding this disease have been progressing, thus allowing it to be specified with greater validity.
As mentioned above, one of the most relevant causes is the presence of a weakened (hypotonic) sphincter, but the presence of a hiatal hernia, which is a hernia in the diaphragm, can also be mentioned to explain the consequence of this. It can be said that under normal conditions the position of the esophagus is above the diaphragm and the stomach is below, so due to hiatal hernia the stomach moves towards the thoracic space causing obstruction between the esophagus and the stomach.
It is necessary to mention the hiatal hernia since people who suffer from gastroesophageal reflux (GER) mostly also suffer from this hernia, but the opposite happens in the case of people who suffer from hernia, in that case they are few people have reflux. The role of hiatal hernia in causing gastroesophageal reflux disease has been investigated but is not yet clear.
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When gastroesophageal refluxes occur, there are different factors that make it possible to determine whether or not gastric juice affects the gastric mucosa. But in normal cases, the esophagus produces a movement called peristalsis that allows it to cleanse itself, in such a way that, when the gastric juice refluxes, it only joins the gastric mucosa in a very short time.
This peristalsis or mobility, when it occurs in a reduced way by the esophagus, causes the end of the mechanism to be lost, since the duration of this cleaning process is lengthened and the gastric juice remains in contact with the mucosa for longer. . Therefore, it is necessary to mention that there are foods that are rich in fat and increase the production of gastric acids that causes loss of mobility, among them are chocolate, spicy, alcohol, mint, coffee, nicotine and spices.
During pregnancy, reflux symptoms occur very frequently, because during this period there are hormones that intervene in the mobility (paristalsis) of the esophagus. There are also other factors or conditions that cause the appearance of this disease, it can also be produced by ingesting some medications.
We must take into account the type of medicines that are ingested, since if you do not have proper care and proper medical attention, these medications could cause reflux and consequently you can suffer from gastroesophageal reflux disease (GERD). Among the most common medications that with heavy use can cause reflux are antidepressants, asthma medications, sedatives, progesterone, and antihistamines.
How can GERD be detected?
To give a diagnosis about a person suffering from gastroesophageal reflux, the symptoms that this person presents must be taken into account, for example heartburn, regurgitation, heartburn, among others.
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The person should go to a gastroenterologist , who will inspect him depending on the symptoms that the patient presents and will assign a corresponding treatment to try to make the symptoms disappear. In the event that the symptoms disappear, the patient does not undergo further tests, but if the opposite occurs and the treatment has not been successful, complications may occur, therefore the doctor must do other tests and change the treatment. .
In the event that a person suffers from very common heartburn, there is a high possibility that that person has gastroesophageal reflux disease, being a 75% probability proportion, so that to corroborate the diagnosis the person must undergo to examinations, including an endoscopy of the esophagus, stomach and duodenum in order to ensure if the diagnosis is true and if the mucosa is inflamed and to what extent it has been affected.
To perform an endoscopy, it is usually performed on an outpatient basis, that is, a hospitalization is not necessary and apart from examining the condition of the mucosa, it also allows observing the state in which all the tissue of the organs affected by cause are found. from reflux and constant heartburn.
An endoscopy is performed with a flexible probe that allows checking the intestinal walls through images that are sent during the process, in addition, if it is necessary to take a tissue sample during endoscopy, it can be done, this is known as biopsy, then that tissue sample is analyzed. This sample is commonly performed in cases of suspected cancer of the esophagus or Barret’s esophagus (esophagus complication).
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Another way to safely determine the diagnosis of gastroesophageal reflux disease (GERD) is through a 24-hour pH test. Through this method it is possible to measure the amount of acid (pH value) in the lower esophagus continuously for the next 24 hours. This test is carried out when the mild disease of GERD is suspected and thanks to it it is possible to determine if and in what quantity the stomach contents are flowing back into the esophagus.
To perform a pH measurement, a probe is entered through the nose that goes towards the esophagus. Through this test, a record of the acid levels in the esophagus that the patient has during a 24-hour period can be made, in addition, all this is done while the patient performs his daily activities in a normal way.
During the 24 hours of the pH measurement period, it is possible to keep a record of all daily activities , such as: sleeping, eating, walking, among others, thus the changes in the person’s pH are observed and its possible causes could be studied. This method is highly recommended to be performed before the person undergoes surgery, to study the changes that occur and even to correct reflux.
Finally, another test that can be performed in case of GERD symptoms will also be mentioned and it is esophageal manometry, which allows a more precise study of how the esophageal sphincter is working, thus it is possible to know if there are any problems in this muscular valve and using this information, preparations can be made for future surgery.
To accurately determine a diagnosis of GERD, the symptoms that the patient presents must be taken into account and also the way in which he responds to the treatment indicated by the doctor. To be able to give a final diagnostic evaluation it is because the symptoms do not obey the treatment or they become chronic, also when esophageal complications occur.
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Upper gastrointestinal endoscopy was for many years the most commonly used method to determine patients with gastroesophageal reflux disease (GERD), since all this procedure allows the detection and a better subsequent control of esophageal manifestations. But because it is poorly sensitive, its use as a diagnostic technique for this disease is being reevaluated.
At present, digestive endoscopy is recommended by the North American Society to be performed on patients who present symptoms of severe reflux or also in people where necessary to rule out the appearance of diseases related to acid secretion.
With regard to ambulatory pH control, it involves the placement of a pH electrode following the inner esophageal sphincter. The most useful quantification to record pH changes and sick reflux is time, in which pH values are kept below 4 during the process.
In double contrast examinations with barium swallow, reflux esophagitis may also be present, in which a kind of mucosa with a certain granular, nodular appearance or with certain thickened folds can be observed, in addition to superficial ulcerations, peptic stenosis or all the symptoms mentioned above in parallel.
Grades and levels of GERD
Regarding the grades and levels, there are various classification systems to determine the severity of this disease and the complications that it could present later. These types of classification have been carried out through studies and clinical trials that have made it possible to observe the efficacy of each of the therapies applied as treatments for esophagitis caused by reflux.
Currently, in terms of its classification, it is more common to hear the Angels named and especially Savary-Miller, which is the most used today in Europe. Regarding the classification of the Angels, there are several advantages, which are mainly:
- Grade A. Mucosal lesions are less than 5 mm corresponding to one or more lesions, these lesions do not extend to the upper part of two folds of the mucosa.
- Grade B. Mucosal lesions are greater than 5mm corresponding to one or more lesions, but these do not present continuity in terms of the upper part of the mucosal folds.
- Grade C. Mucosal lesions correspond to less than 75% of the total esophagus, include one or more mucosal lesions that have continuity.
- Grade D. Mucosal lesions involve at least 75% of the total circumference of the esophagus, corresponding to one or more mucosal lesions.
Regarding the Savary-Miller classification for gastroesophageal reflux disease (GERD), we have the following:
- In Grade I. In this grade only one fold corresponding to the longitudinal one is affected, it is an individual or isolated erosive lesion, it can be oval or linear.
- In Grade II . More than one fold of the longitudinal area is affected, as a consequence of multiple erosive lesions, not necessarily in the circumference and it manifests with or without confluence.
- In Grade III. In this grade the lesion known as circumferential erosive occurs.
- In Grade IV. Chronic lesions occur, in the same way as ulcers, strictures, short esophagus problems, and can occur alone or in association with types of lesions from I to III.
- In Grade V. In this last grade, columnar epithelium is present in continuity with the Z line, in addition they appear in a non-circular way, it can manifest in the shape of a star or circumferential, and this can be shown alone or associated with grade I to lesions. IV.
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GERD and its pathophysiology
As for the pathophysiology of this disease, it becomes difficult since it is subject to a model that presents different factors involving various mechanisms, such as digestive, neuroendocrine, respiratory and psychological. Therefore, in terms of his theory, he has a history that closely links it with hiatal hernia and recently in his studies it has been shown that the malfunction of the inner esophageal sphincter is one of the fundamental causes of this disease.
At present, some of the most relevant studies on pathophysiology indicate that this disease occurs due to multiple factors and it is accepted that this disease is the result of defensive and aggressive imbalances at the level of the esophageal mucosa.
GERD and affected organs
When reflux occurs constantly, the acids involved in the event damage the cells of the esophagus and can often cause the appearance of another disease known as Barret’s syndrome, which causes problems when swallowing due to great discomfort, the consequences of this syndrome is that it causes the patient to lose weight rapidly and in the worst case, esophageal cancer develops.
Aside from Barret’s syndrome and cancer, having a damaged esophagus causes great pain in the chest, so much so that it is often mistaken for a heart attack. With prolonged contact between stomach acids and the esophagus, bleeding ulcers develop.
At the time of reflux, stomach acid often rises up the throat, thus producing another disease known as laryngo-pharyngeal reflux (LRF). Patients who present this case experience a certain type of burning in the throat due to acids, many times there are also breathing difficulties and bitter tastes in the mouth. When this disease occurs in children it can also cause loss of sleep and difficulties in consuming some foods.
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When laryngo-pharyngeal reflux occurs, the ears can become inflamed and irritated and even more, it can cause ear infections and diphtheria as a result of this reflux. Another condition that can occur as a result of these refluxes is laryngitis and throat clearing, which affects hearing causing discomfort in the ears, in addition to affecting the respiratory tract.
In the case of people who suffer from asthma, they have a greater possibility that their lungs are affected by reflux, since when the inner esophagus relaxes the acid goes into the airways, when this happens, the airways become irritated and As the nerve pathways near the lungs are stimulated, then as a consequence the acid is allowed to enter the lungs.
These types of people commonly suffer from bronchitis and pneumonia since these diseases are linked to lung irritation that is caused by excess acid in the lungs. So that people become more susceptible to various external factors such as smoke, air pollution, and also cold air, all of which make it difficult for them to breathe.
When the mouth is affected due to reflux, sensations of bitter taste and bad breath are produced, injuries are caused due to the excessive amount of acids in the mouth, also over time the tooth enamel erodes and increases the probability cavities. All teeth are affected, and in children this acid reflux makes them even more vulnerable, mainly in the deterioration of teeth, as well as the appearance of cavities.
Symptoms of GERD in adults
The most characteristic symptoms that an adult can present due to GERD are heartburn or what is known as acid regurgitation. This sensation of acidity is like a burning in the throat due to the acids that affect the mucosa, it is also known as heartburn and is felt behind the sternum. So acid regurgitation in the chest caused when gastric fluids rise into the esophagus and can reach the mouth.
Other symptoms that an adult may present due to this disease are constant chest pains, sore throats, aphonia due to irritation caused by gastric acids in the larynx, it may also present cough, asthma and breathing difficulties due to organs affected by reflux.
Symptoms of GERD in children
The most frequent symptoms that children and adolescents can present are heartburn, many times as a result of the type of food that has been consumed, more frequently in infants, this heartburn can take up to two hours and often tends to get worse.
In the event that the heartburn worsens, problems such as vomiting or gastric regurgitation occur frequently, especially after meals, choking may also occur due to the content of gastric reflux, in addition to wet belching. The youngest children, when presenting this pathology, cause them great discomfort and restlessness, especially after eating, many times they lose their appetite, which prevents them from gaining weight.
GERD during pregnancy
During pregnancy it is very common for a woman to have symptoms of gastroesophageal reflux, this begins from the first days of pregnancy and as the months go by it can increase. The frequency of reflux in a pregnant woman is due to the fact that in that period of time the muscles that carry food from the esophagus to the stomach work very slowly, which many times causes the food to be returned, in addition to that as time passes and the uterus grows, the stomach is pressed, and stomach acid can leak into the esophagus.
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Although reflux symptoms during pregnancy are quite common, they can often cause complications such as esophagitis, but these symptoms disappear after the baby is born. Therefore there are treatments for pregnant women which must be indicated by the doctor in order to have better control during this period.
What is the lower esophageal sphincter?
Throughout the entire segment of the esophagus, it has been shown that there is a part with high pressure which is called the lower esophageal sphincter, this area is usually between 2 to 4 cm long and is located above the thoracic cavity and below the abdomen . In this place there is an asymmetric muscular thickness made up of arcuate fibers.
Lower esophageal sphincter function
The main function of the lower esophageal sphincter is to allow the passage of food that passes through the esophagus into the stomach, once the food passes, the sphincter closes to prevent food from being returned back to the esophagus. This sphincter is usually weakened by various factors, mainly by obesity, excess fat and other diseases that directly or indirectly affect this sphincter.
When the sphincter begins to fail or weaken, different symptoms of gastroesophageal reflux begin to appear and the person begins to suffer from heartburn because gastric acid refluxes into the esophagus and there is a risk of suffering from GERD.
Upper esophageal sphincter
This sphincter is located between the pharynx and the esophagus, just after the periphery sinuses and is responsible for preventing the passage of air through the digestive tract and gastric reflux into the pharynx. Like the inferior sphincter, it is usually 2 to 4 cm long and is a muscle made up of the inferior constrictor of the pharynx .
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Function of the upper esophageal sphincter
This sphincter works like a valve and works in harmony with the tongue and other muscles in the upper part of the pharynx, when food is consumed the sphincter opens, allowing the passage of food and liquids to pass into the stomach, then closes again to prevent the person from making unwanted aspirations.
Alcohol and esophageal sphincter
Alcohol consumption is one of the most recognized causative factors of gastroesophageal reflux, although it manifests differently in each person, several recommendations need to be taken into account if you want to drink alcohol and have a history of reflux symptoms, among these are: Drink alcohol in a moderate way, do not drink before going to bed (at least wait two hours), maintain a diet that helps reduce alcohol levels, among others.
What is hypotonic esophageal sphincter?
When we speak of the hypotonic esophageal sphincter (LES), it refers to a state of rest with contraction of the sphincter, which is only temporarily relaxed by allowing food to pass through. This relaxation and contraction is measured by nervous stimuli. This sphincter is characterized by having a pressure lower than 10 mm Hg, while a useless sphincter is one with a pressure lower than 4 mm Hg. When this type of sphincter occurs then there is an increase in intra-abdominal pressure.
What is called a hypertensive esophageal sphincter?
Called EEIH (Hypertensive Lower Esophageal Sphincter) and corresponds to a disorder of the esophagus that is usually rare. In the past, there was no clear diagnostic definition in this regard, which has caused difficulties in determining its prevalence and also its clinical characteristics.
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What does hypertonic esophageal sphincter mean?
When mentioning the inferred hypertonic esophageal sphincter, reference is made to esophageal pressure greater than 50mmHg, when under normal conditions it should be 15mm Hg. Moments may occur when the sphincter does not relax completely and the pressure rises until it is higher and occupies the values between 60-100 mm Hg.
Why is it called a hypotensive esophageal sphincter?
One of the most favorable reasons for gastroesophageal reflux (GER) is the uselessness of the LES, so that the sphincter loses its anti-reflux capacity. As for the resting pressure, it is normally low, which confirms that it is a hypotensive sphincter or also because the length of the sphincter is small.
Lower esophageal sphincter and cardio, is it the same?
They are not the same, the cardia is positioned a short distance from the z-line and next to it is the lower esophageal sphincter, although this can only be demonstrated physiologically and certain controversies have arisen in the past regarding the location of the cardia, lately it has been agreed that the card is part of the stomach.
Natural treatments for esophageal sphincter
As natural treatments to improve the condition of the sphincter, the following homemade recipe should be taken into account:
- Raw almonds to help balance the pH of the stomach.
- To minimize lesions of the esophagus, ingest a maximum of 60 ml of aloe vera.
- To relieve heartburn, drink a glass of warm water with a little lemon while fasting.
- After eating a lot of food, it is recommended to eat a red apple.
- To relax the stomach, have a cup of chamomile or mint tea.
- To reduce gastric acids, chew peppermint gum.
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General recommendations for the esophageal sphincter
Reduce the amount of food
You can experience a higher frequency of reflux as a result of what we consume during the day, if at lunch and dinner the food contains high levels of fat, it is very likely that you will have reflux during the day.
Don’t fall asleep immediately after eating
At the time of going to bed it is necessary to wait at least an hour after consuming food, since if we do it immediately after eating there are high possibilities of suffering from reflux. This condition applies both for night rest, as well as for naps during the day.
Sleep with your head elevated
It is recommended for people who suffer from reflux, to sleep with the head elevated, so that it is above the stomach and prevents the sphincter from opening and refluxing the stomach contents into the esophagus. To achieve this position, you can sleep with more pillows or raise the head of the bed by placing studs under the legs.
Avoid smoking and drinking coffee or alcoholic beverages
In the case of consuming coffee and alcohol, problems with the sphincter occur, since it is stimulated more than normal and does not allow it to relax and as a result of this, it does not close as it should. In the case of tobacco, the stomach is affected, as it damages the mucosa and relaxes the valve of the esophagus.
Maintain an adequate weight
It is not about aesthetics although it is always good to try to avoid obesity, since the accumulation of fat in the abdominal part causes greater pressure on the stomach and as a consequence causes the sphincter to open.
Avoid consuming liquid meals
In case of constantly suffering from reflux it is better to avoid consuming liquid foods, such as soups, smoothies, smoothies, broths, since these worsen the condition of people by increasing the levels of symptoms.
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Don’t drink while eating
It is recommended that if you are going to drink water, it be done half an hour before eating or half an hour after finishing, even if it is natural water, it is not recommended to do it while eating. Then in the rest of the day, it can be done at any time.
Kathie Sand always saw the world of beauty as the terrain on which to build her professional career, a goal that was clear to her when she was only 15 years old. Her great concern to expand knowledge led her to settle in Paris where she studied hand in hand with the best beauty professionals and with the most advanced techniques for skin care.