While ingesting food there are a lot of components that aid in digestion. One of them is acid, which helps in the digestion process; other components like bile and pepsin (which helps digest the protein that one has ingested) are also part of the regurgitated liquid. Gastro esophageal reflux disease or GERD, as it is known is where the acid is regurgitated into the esophagus and damages the esophageal lining. Although there are other components in the regurgitated liquid their role is not clearly understood but this disease inflames the esophageal lining and can cause serious damage to the food pipe. This is a chronic condition and has to be treated before injury to the esophageal lining called esophagitis. It is also to be noted that once this disease has set in it is generally there for a lifetime. The damage to the esophagus can be treated with medication but it has been noticed that once the treatment is stopped the problem recurs within a few months. Generally the body has methods of combating reflux.
While one is upright due to gravity most of the liquid flows back and swallowing that a person does releases the bicarbonate rich saliva which neutralizes the remaining acidic fluid, hence there is no damage to the esophagus in general but reflux during the night is not countered with these body mechanisms and thus can lead to GERD and damage the esophagus. People susceptible to GERD are pregnant women and those who have mixed connective tissue disease (scelroderma). Cause of this disease can be from low esophageal sphincter muscles, hiatus hernia and esophageal contractions that empty the stomach contents. Heartburn, nausea and regurgitation are the common symptoms of regular GERD. Most common complications of this are ulcers caused due to acid in the esophagus, shrinkage of the scar tissue and thus forming strictures and finally when there is reflux, the cells in the esophagus change and these changes can be termed to be pre-cancerous and slowly turn cancerous this is called Barrett’s esophagus.
Other problems are cough asthma, throat inflammation, ear and lung infection etc. the first approach is to treat the heartburn and see how the patient responds but if the doctor suspects that this could be a tad more serious than that then he may make is evaluation after conducting tests like Endoscopies, biopsy (if an ulcer is found, x-ray's, throat exams, Esophageal acid and motility tests and so on. GERD is treated with medication but primary lifestyle changes can include lying with upper body elevation while sleeping, small and early evening meals are often recommended and dietary changes can include avoiding foods that are hard to digest like sweets or fatty or spicy foods, citrus juices, tomato juice, alcohol, affricated beverages, avoid smoking. Chewing gum is recommended now since it increases the production of saliva and thus can neutralize the acidic properties of the fluid being refluxed. Antacids remain the major relief factor but in severe cases surgery is the last resort. Lifestyle changes and antacids as also non-prescription histamine antagonists still remain the best approaches to this problem.
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