GERD is caused by abnormal regurgitation of fluids from the stomach into the esophagus. The stomach generates strong acids and enzymes to aid in food digestion. This digestive mixture is called gastric juice. The inner lining of the stomach has several mechanisms to resist the effect of gastric juice on itself, but the mucosa of the esophagus does not. The esophagus is normally protected from these acids by a one-way valve mechanism at its junction with the stomach. This one-way valve is called the Lower Esophageal Sphincter (LES), and prevents gastric juice from flowing back into the esophagus.
In patients with GERD, the LES malfunctions, most often because it is either too weak or too short. The short or weak LES cannot hold the contents of the stomach as it fills up and the pressure inside it rises. When the LES fails, gastric juice flows backwards - refluxes - up into the esophagus, which is not designed to handle it.
Since the gastric juice is normally very acidic, it burns the lining of the esophagus. The patient then feels "heartburn" or "acid indigestion". Heartburn feels like a burning or pressure pain behind the breastbone. If the acid is in the esophagus, and you belch, it may regurgitate on up into the back of your throat, tasting sour or bitter. If this process happens at night, you may awaken in the night, either with a hot, fiery feeling in the back of your throat, or even coughing and gasping from the acid mixture getting into your breathing tubes. This last phenomenon is called Reflux Nocturnal Aspiration, and can be quite serious in itself.
Reflux Nocturnal Aspiration is dangerous, because it introduces acid and bacteria into the airway and lungs. This can cause recurrent bronchitis, pneumonia, lung abscess, and chronic scarring of the lung. It can also lead to asthma attacks in persons with an asthmatic tendency.
When acid reflux and these symptoms occur daily or even 3 - 4 times per week, the esophagus cannot withstand the damaging effects of the acid bath, and becomes inflamed, red and raw, especially at its lower part. Swallowing can be constantly or intermittently painful, and food may begin to stick in the chest. This is called reflux esophagitis, meaning inflammation of the esophagus, due to acid reflux. Persistent esophagitis can cause erosions and ulcers, and can lead to scarring and narrowing, and irreversible injury to the esophagus.
In some patients, as the esophageal lining becomes increasingly damaged, the body may take steps to try to protect it, by changing the lining material to a more resistant type, such as found in the intestine. This change, called Barrett's Esophageal Metaplasia, or Barrett's Esophagus, does not make the symptoms go away, and actually produces a new problem. Metaplastic changes increase the risk that a cancer will form in the new and abnormal lining. Adenocarcinoma of the Gastroesophageal Cardia is a highly malignant and fatal type of cancer, the incidence of which is increasing rapidly in America. Some authorities believe that Barrett’s esophagus is caused by bile reflux, and that the rising incidence of this particular type of cancer is due to the increasing use of medication that entirely suppresses acid production, this allowing the alkaline bile to reflux unopposed into the esophagus.
The symptoms of acid reflux are very uncomfortable and usually cause you to seek some sort of relief. Many persons chew antacid tablets frequently, sleep on several pillows, or even sleep upright in a recliner. Patients with frequent symptoms are treated with drugs which interfere with formation of acid in the stomach: Drugs may work well to relieve symptoms, usually for a few hours, untill the next dose is due. They do not correct the underlying problem, so they have to be taken every day, often for life.
Currently, the only established way to restore the valve function is to perform a surgical procedure. There are several methods to augment the valve. Most involve wrapping part of the stomach around the lower esophagus. The surgery may be pefromed laparascopically or as an open procedure. Either way, it requires hospitalization for a few days, is associated with a significant complication rate and includes incisions in the body.
It is estimated that in the US alone, 65 million people suffer from heartburn, and GERD symptoms are currently the most common complaint of patients who consult with gastroenterologists. A non-operative solution to the underlying problem of GERD can be an attractive alternative to both surgery and medications for millions of patients worldwide.
Prevalence of GERD.
GERD has long been recognized as a significant public health concern. It is estimated that nearly 44% of adult Americans experience monthly "heartburn". 18% of the adult population is using nonprescription medication for this problem, and 13% use it at least twice a week.
|