Anatomic cause is loose sphincter. There is a band of circular muscle (sphincter) at the end of the food pipe before stomach begins which acts like a valve preventing backwash of stomach contents into the esophagus.

Gastroesophageal reflux disease (GERD) is one of the most frequently occurring diseases caused by a condition when acid from the stomach back flows into the esophagus causing food pipe irritation. This disease troubles people of all ages with varying degrees at least once a week – usually more.

Symptoms

1. Heart burn after a meal usually at night with recumbency
2. Chest pain
3. Difficulty in swallowing
4. Cough
5. Laryngitis and voice change
6. Regurgitation of sour (acidic) food
7. Asthma
8. Sleep disturbance

Cause

Anatomic cause is loose sphincter. There is a band of circular muscle (sphincter) at the end of the food pipe before stomach begins which acts like a valve preventing backwash of stomach contents into the esophagus.

Aggravating Factors

1. Obesity
2. Pregnancy – because of increased abdominal pressure in later stages and muscle relaxing hormones
3. Connective tissue disease – collagen abnormalities
4. Smoking
5. Alcohol
6. Hiatal Hernia – gap in the diaphragm separating the chest from the abdomen resulting in stomach sliding in the chest and back wash of the contents into the food pipe
7. Large meals
8. Lying down soon after meals
9. Fried foods, fatty foods, caffeinated beverages, tomatoes, cheese are common culprits
10. Medications like aspirin, NSAIDS and muscle relaxers

Also Read: Types of Abdominal Pain and Appropriate Treatments

Complications

1. Scarring of the esophagus from constant irritation by stomach acid leading to narrowing
2. Acid from the stomach damages the lining of the esophagus giving rise to ulcer
3. Barretts esophagus which is a precancerous condition and may lead to cancer of the esophagus

Diagnosis

1. EGD – Esophagoduedonoscopy. Scope (camera) is passed from the mouth to the stomach. Inflammatory changes are visible.
2. Acid Test – like a litmus test. Tester is passed into the food pipe to check for the pH.
3. X-ray – barium swallow shows back flow of the barium contrast into the food pipe from the stomach.

Treatment of Food Pipe Irritation

1. Lifestyle modification – dietary habits, time of eating, amount consumed, beverages and any other aggravating factors.
2. Over the counter medications.
• Antacids provide short lasting relief – Tums and Mylanta are common examples.
• H2 blockers take longer to act but provide longer relief like Pepcid and Zantac.
• PPI – proton pump inhibitors. Prevent acid from forming like Pantoprazole and Omeprazole.
3. Same group of medications can be prescribed at higher doses by healthcare providers.
4. Surgery/Procedures
• Fundoplication – proximal stomach is wrapped around the esophagus. It is performed both surgically and endoscopically.
• LINX – magnetic beads are placed at the end of the food pipe. The beads stick to each other bringing the esophagus walls closer.
• Transoral Incisionless Fundoplication (TIF) – same as the first one but performed from the mouth.

Also Read: Delay in Seeking Healthcare Leads to Dire Consequences

Lifestyle Modification

1. Weight loss
2. Tobacco cessation
3. Do not sleep immediately after meals
4. Lying at least 30 degrees head elevation
5. Eat slowly and chew thoroughly
6. Avoid alcohol and caffeinated beverages
7. Caution with fried and fatty foods
8. Wear loose clothing around the abdomen

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