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GastroEsophageal Reflux Disease
What is the Problem?
GERD is caused by abnormal regurgitation of acid fluids from the stomach into the esophagus. The stomach generates strong acids to aid in digestion of your food. The esophagus is normally protected from these acids, by a one-way valve mechanism at its junction with the stomach, which is called the "cardia". The function of this valve may become defective, either due to mechanical distortion, as might occur with a hiatus hernia, or by pressure effects and inflammation, such as occurs in obesity.
When the valve mechanism fails, acid flows backwards - refluxes - up into the esophagus, which is not designed to handle it. The result is an acid burn, which is commonly called "heartburn", or "acid indigestion". This feels like a burning or pressure pain, behind the breastbone -- it may feel very much like a heart attack. When the acid is in the esophagus, and you belch, it may regurgitate on up into the back of your throat, tasting sour, and burning. 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.
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 upright in a recliner. Within the last few years, frequent symptoms have come to be treated with drugs which interfere with formation of acid in the stomach: Tagamet, Zantac, Pepcid, Prilosec. These medicines work well to relieve symptoms, usually for a few hours, till the next dose is due. They do not usually correct the underlying problem, so they have to be taken every day, often for life -- and they are quite expensive.
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.
The esophageal lining becomes increasingly damaged, and 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 -- probably due to larger numbers of persons who are obese, and suffer from GastroEsophageal Reflux Disease.
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.
How Does Obesity Affect GERD?
Obese persons have a very high incidence of GERD symptoms. Medical textbooks describe the typical patient as husky or obese, and advise that weight loss is a major goal in treatment.
What Should You Do?
First, determine if you may have the problem. The symptoms are very noticeable, and very uncomfortable, but so common that many persons think of them as almost a normal part of living, and do very little about it.
Do you have two or more of these symptoms?
If you have these symptoms occasionally, you may find relief from drugs such as Zantac or Tagamet, which you can buy without prescription at a pharmacy.
If these symptoms occur 3 - 4 times each week, you should consult your personal physician, or Primary Care Physician, for evaluation and advice, and treatment.
Barrett's Esophagus and Cancer - What should be done?
Unfortunately, many physicians are unaware of the association of frequent reflux symptoms with the occurrence of Barrett's Esophagus. Experts in esophageal disease estimate that as many as 10% of persons who have reflux symptoms 3 - 4 times each week may have some degree of metaplastic pre-cancerous changes at the gastroesophageal cardia. Each year, some of those persons will develop cancer.
We believe that any person who has frequent or daily reflux symptoms should undergo examination and biopsy of the esophagus - a simple and minimally uncomfortable examination which is done in about an hour. If biopsies show changes, the examination will have to be regularly repeated, once a year.
What Tests are Needed to Evaluate GERD?
Several tests evaluate different aspects of the problem, and aid in selecting the best treatment.
The Effect of Gastric Bypass on GERD
Gastric bypass produces complete relief of GastroEsophageal Reflux symptoms in nearly all patients. There are several effects of the operation which bring this about:
Gastric Bypass is more successful as a surgical treatment for GERD than the operations specifically aimed at the problem -- the Nissen Fundoplication and the Hill Gastropexy. At the same time, it treats the primary cause -- Obesity.
GERD is a major co-morbidity of severe obesity, and is life-threatening in several ways. Gastric bypass is a very effective treatment.
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