Gastroesophageal reflux disease is a chronic digestive disease (digestive disorders) that affects to lower esophageal sphincter, the ring of muscle between the esophagus and stomach. It occurs when the digestive fluids such as HCL, Pepsin, and sometimes the foods going from the stomach to the esophagus, these substances stimulate to esophageal mucosa and cause gastroesophageal reflux disease.
Any one could get gastroesophageal reflux disease, from infants to elderly people. Especially, it often occurs in infants and babies since the parents often do not pay attention and it is very difficult to distinguish the reflux with the vomiting physiology phenomenon. So we need to pay more special attention to infants and babies because of this confusion.
There are a variety of reasons cause gastroesophageal reflux disease, but the inordinate eating and working habits such as usually staying up late or eating while working, having stress, having unusual eating habits (sometime skip your meals, sometimes eat too much) or having peptic ulcer, antral inflammation for long time without any treatment are the main reasons causing gastroesophageal reflux disease besides congenital causes.
Normally when you swallow foods, the lower esophageal sphincter (the ring of muscle between the esophagus and stomach) relaxes to allow food and liquids to flow down into your stomach and then closes again following its operating principle. Being gastroesophageal reflux disease, the lower esophageal sphincter relaxes unusually or your stomach increases contractions making digestive juices in stomach backflow to the esophagus.
There are several factors making gastroesophageal reflux disease more seriously such as: eating too much fatty and oily food, too much spices, chocolates, caffeine, onion, tomato sauce, sparkling water and mint or lying down right after eating. There are some types of medicine such as tranquilizer, sleeping pill or calcium channer blocker may also cause gastroesophageal reflux disease. Smoking is also one of the reasons that increase gastric secretion causing this disease. And HP bacterium causes gastritis also making gastroesophageal more seriously.
What are symptoms of gastroesophageal reflux disease? Is gastroesophageal reflux dangerous?
The most common symptoms of gastroesophageal reflux disease are:
Having heartburn with burning sensation from stomach or lower chest to the esophagus. The digestive juices reflux to the esophagus causing cough and burning sensation at the throat, and especially chest pains and chokes on sternum because digestive juices stimulate to the esophagus.
Approximately 2/3 of patients have dyspeptic disorders, they eat but can not digest (feel painful and uncomfortable at the epigastric region) and about 40% of patients have irritable bowel syndrome also have gastroesophageal reflux symptoms. There are other symptoms like difficulty swallowing, odynophagia, difficulty breathing at night, vomiting blood or quickly losing weight…to warn you that the disease has become more seriously or has complications concerned or may have another disease.
Having chest pains or tightness usually caused by gastric acid overflowing into the esophagus. This is one of the most common symptoms of gastroesophageal reflux disease. Stomach acids will overflow more to the esophagus when lying on bed or bowing down, thereby causing heartburn.
Having pain after you eat, especially after eating a lot of foods that makes your stomach overloaded since there is not enough space for storing and it causes gastric juices and food refluxed. In some cases, gastric acid (stomach acid) may reflux or back up into the esophagus causing bitter taste in the mouth, even causing choke. For some patients, the only symptom of stomach acid reflux is nausea. If you feel sick, tired or restless and do not know why, you should think about refux phenonmenon. If you got these symptoms after having meals, it is likely to be gastric acid reflux.
Acid reflux may swell up the lower esophageal tissue thereby narrowing the esophagus and causing dysphagia. This disease may cause other related symptoms such as esophageal ulcers, esophageal stricture, esophageal cancer or laryngeal cancer. Gastroesophageal reflux occurs regularly, day by day may damage the esophagus.
How to treat Gastroesophageal reflux disease?
The goals of gastroesophageal reflux disease treatments are: to eliminate the symptoms of disease (or bring the symptoms under control), to heal esophagitis (injury or inflammation of the esophagus) if there is, to prevent esophageal stricture, to avoid scratching mucosa and being recurred ulcers, and to maintain treatment achievements. So there are several medications that can be used to treat gastroesophageal reflux disease.
There are 3 major ways to treat gastroesophageal reflux disease. Here they are:
Western medicine treatment:
For mild symptoms: initial treatments for mild gastroesophageal refluxe include dietary changes and using prescription medications to increase gastric tone which determines the sensitivity of the stomach to distension such as: Metoclopramide, Domperidone, Cisapride or Antacid tablets, Alginic acid. Patients can take Omeprazole, Lansoprazole,…before the meals to surround gastric mucosa. These medications are popular selling at pharmacy drugstores, however this disease is easy to recur after stop using medication, therefore maintaining treatment or using prescription medication is really necessary
Traditional Chinese Medicine treatment
The development of science indicated that Traditional Chinese Medicine treatment can cure gastroesophageal reflux, and it helps patients achieve and maintain the health. This treatment is herbal therapy using plants, roots and leaves, flowers, rind, trunk….available in natural environment. This method requires patients have to be persistent and must follow a healthy dietary, since it normally takes quite long time to get result. This herbals medicine often has no side effects or less than western medicines.
Surgical therapy is also an option for the treatment of Gastroesophageal reflux disease. Surgery may be recommended if you have serious complications and is usually a last resort. The main indication for surgical therapy is failure of medical management when symptoms persist despite appropriate medical therapy. There are several surgical options that may help to relieve Gastroesophageal reflux disease symptoms and manage complications. Speak with your doctor for guidance on the best approach to manage your condition. The successful rate is about 85%, however this method is quite expensive.
Metoclopramid: helps to increase movement, and promotes to open pyloric spincter thereby less pressure to the stomach reducing gastroesophageal reflux. But it has side effects: causing insomnia and increasing extrapyramidal tone.
Domperidone: this is peripheral antidopaminergic drugs; it is fixed to the peripheral D2- receptor and not goes through the blood-brain barrier. It helps to increase pressure on the lower esophageal sphincter to support stomach digest food so reduce reflux. It contraindicates to any one having gastrointestinal bleeding, bowel obstruction, or risks of gastrointestinal tract perforation
Sulpirid: works to increase the lower esophageal sphincter tone, helps to keep food does not reflux into the esophagus. It also has effects to the central nervous system such as sleeping pills, so it has side effects like insomnia, extrapyramidal syndrome, and milk leaking…
Metopimazin: this is a phenothiazine antiemetic. It works to change gastrointestinal tract movement but do not inhibit combination drugs absorption.
In addition, there are some special cases may take some other drugs like alizaprid, anzemet, zelmac depending on the clinical situations.
Alginat: alginic acid combines with HCL forming floating foam on gastric juice. This helps to protect the esophagus lining away from gastric acid impacts
Dimeticol is mucosal protectants working similar to Alginate.
Mucosal protector drugs
Sucralfate may form a complex with protein substrates creating a barrier to protect gastric mucosa. Sucralfate is often prescripble for cases having mild or serious reflux condition. Do not use antacids or H2 antihistamine half an hour after taking sucralfate.
Besides that, antiacids (Maalox, phosphalugel,..), H2-receptor antagonists (such as cimetidine, rantidine, nizatidin, famotidine) or proton pump inhibitors (such as omaprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole) are also used depending on the clinical condition of each patient.
Nowadays, proton pump inhibitors are the most effective and widely used therapy for gastroesophageal reflux disease and have been remarkable successfully. Half of patients can maintain achievement by using proton pump inhibitors treatment or H2-receptor antagonist. Especially, patients have to maintain a reasonable dietary and living habbits to contribute to gastroesophageal reflux disease treatment. Do not eat too much food per meal, you can eat several meals (4-5 meals per day) but eat little. Patients should eat dense and dry healthy foods, limit liquid ones. Do not lie down right after eating. Eveluate the bed and raise the head.
Quit some foods that decrease sphincter tone such as: chocolate, coffee, fatty foods, sparkling water. Let eat slowly, chew thoroughly, and avoid swallowing air into the stomach. Do not use some medicines that decrease the lower esophageal sphincter tone such as estrogen, progesterone, anticholinergic, barbiturates, calcium inhibitors, diazepam, and theophyline. Only take surgical treatment when medical treatment can not help and there are severe complications.
Food and lifestyle advice for people with gastroesophageal reflux diseas:
Balancing your dietary and lifestyle habits is the best way for people to prevent gastroesophageal reflux disease since unlike many conditions, it is completely preventable.
For patients who are following gastroesophageal reflux disease treatment must control their lifestyle habbits like: control and balance eating habbits, quit smoking, cut back on alcohol, avoid being stressed out. Doing Tai Chi or Yoga is one of the best ways to promote and improve treatment benefits.
You should avoid foods known to cause refluxe such as fatty foods, spicy foods, chocolate, onion, caffeine, carbonated beverages, … And eat small meals, large meals will fill stomach and put pressure, you can eat several meals in a day with small amount. It is also not recommended to do hard activities or lie down after eating, and you should raise the head of your bed to keep gastric acid down in your stomach. Don’t use extra pillow too. And do not wear tight clothing or belts than can constrict your stomach.