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Gastro Oesophageal Reflux - Gastro Oesophageal Reflux symptom, treatment, causes

Gastro Oesophageal Reflux occurs due to the regurgitation of the contents of the stomach into theoesophagus (gullet). The stomach lining produces a thick mucus that protects it from damage bytheconcentrated hydrochloric acid and digestive enzyme (pepsin) produced in the stomach. The oesophagus does not have this protection. The sphincter (muscular valve) between the lower end oftheoesophagus and the stomach normally closes after swallowed food or liquid enters the stomach, preventing reflux and irritation of the oesophageal lining. Occasionally it allows some reflux of food and stomach secretions - for example when the stomach is very full, on lying down after a big meal, or because of pressure from the enlarging uterus in pregnancy. About one-third of adults experience a brief bout of heartburn (intermittent burning pain behind the breastbone) due to reflux at least once a month. If the sphincter stops working properly for, a prolonged period, repeated exposure to stomach acid and pepsin damages the lining of the oesophagus and symptoms become constant.

Gastro-oesophageal reflux is a condition where the lower oesophageal sphincter is abnormally relaxed and allows the stomach's acidic contents to flow back or 'reflux' into the gullet. It is caused by failure of the sphincter mechanism at the lower end of the oesophagus. Symptoms of gastro-oesophageal reflux can be broadly grouped into those directly related to reflux episodes such as heartburn, regurgitation and waterbrash; and those symptoms caused by complications of reflux disease, including dysphagia and respiratory symptoms. It can also cause heartburn. Factors that predispose to reflux include increased intra-abdominal pressure, inadequate cardiac sphincter for anatomical reasons or factors that reduce tone and also poor oesophogeal peristalsis. Most of these predisposing factors increase intra-abdominal pressure and a fatty meal delays gastric emptying but the listed drugs and smoking relax the tone of the cardiac sphincter. There is no relationship between heliobacter pylori infection and gastro-oesophageal reflux. Regular exposure of the oesophagus to acid from the stomach can change the lining of the oesophagus so that it is more like the lining of the stomach and so more resistant to acid. Another problem associated with reflux is that it can cause a crushing pain in your chest and this can feel the same as the pain of angina or a heart attack, and as such these conditions can be confused and misdiagnosed.

Gastro-oesophageal reflux is a common condition and the most frequent cause of indigestion in the world. Patients with symptomatic gastro-oesophageal reflux do not develop local mucosa complications or complications to the lining of the gullet, but the symptoms can be as severe as those experienced with erosive oesophagitis. Almost everyone has occasional symptoms of heartburn. However, frequent heartburn, or other symptoms that do not improve with antacids or other over-the-counter medications, may be a sign of a more severe problem, such as erosive gastro-oesophageal reflux. Gastro-oesophageal reflux may be diagnosed by a barium x-ray examination. This is a series of x-rays taken as your child swallows a special drink to track progression of the drink down the oesophagus and into the stomach. Reflux is less likely to occur when the volume or size of the meal is kept small. Medical treatment of gastro-oesophageal reflux is usually tried first. This can involve feeding your child in an upright position, using thickened feeds and giving your child medication. If your child's condition does not respond to this treatment, he or she may need an operation. The operation is called a fundoplication.

Causes of Gastro oesophageal reflux

The common causes and risk factor's of Gastro oesophageal reflux include the following:

• Eating a large or fatty meal.
• Smoking.
• Drinking alcohol.

Symptoms and Complication of Gastro Oesophageal Reflux

The most prominent symptoms of Gastro Oesophageal Reflux are heartburn and/or regurgitation of stomach contents into the mouth, causing a bitter taste (waterbrash). Reflux can also cause constant bad breath, persistent sore throat and throatclearing, cough and hoarseness. Symptoms of complications include constant pain behind the breastbone and on swallowing from OESOPHAGITIS or PEPTIC ULCER DISEASE of the oesophagus, vomiting blood from deep ulcers in the oesophagus. and difficulty with swallowing from narrowing (stricture) due to formation of scar tissue in the inflamed oesophagus or healing ulcers. Diagnosis of reflux and its complications is by a barium swallow X-ray or endoscopy !internal examination via a viewing instrument). Some sign and symptoms related to Gastro oesophageal reflux are as follows:

• Vomiting.
• A painful or burning sensation in the upper abdomen or chest, sometimes radiating to the back (heartburn).
• Excess belching is common.
• A small number of patients have difficulties breathing and suffer from hoarseness because the refluxed fluid irritates the larynx and respiratory tract.
• Weight loss.
• Failure to thrive.

Treament of Gastro Oesophageal Reflux

Uncomplicated reflux can often be controlled by non-medical treatment such as raising the head of the bed 10-15cm, avoiding food or drink that stimulates stomach acid secretion (such as caffeine in coffee, tea and cola drinks), limiting the intake of alcohol, and avoiding fatty food and smoking, which relax the sphincter. The next step is to use simple medications, such as antacids to reduce gastric acidity, and other drugs to improve the function of the sphincter and the muscle contractions that move stomach contents onwards Complicated reflux seldom requires antireflux surgery these days. as doctors can now prescribe drugs that promote ulcer healing. Narrowing of the oesophagus is treated by passing an inflatable tube or rods of increasing diameter through it. Here is list of the methods for treating Gastro oesophageal reflux:

• Gastro-oesophageal reflux disorders are mainly treated by medicines that reduce stomach acid . In most cases, antacids successfully control the symptoms.
• If simple antacids are insufficient to control the symptoms, then tablets to reduce acid secretion will usually be tried. This often starts with medicines called histamine H2 antagonists.
• In a small number of cases where medical therapy has been unsuccessful, the problem may be solved by a laparoscopical (key hole) surgical procedure in which the oesophageal sphincter is strengthened.
• Non-steroidal anti-inflammatory drugs. These include drugs such as aspirin and ibuprofen.
• Calcium channel blockers (these medications are used in the treatment of high blood pressure and angina).

Reflux in Babies

Most infants bring up small amounts of milk (seldom more than 10 mL) during or after feeds, often when being burped. Occasionally babies have a lax sphincter that allows larger amounts of their stomach contents to be regurgitated regularly, which may lead to reflux oesophagitis or rarely oesophageal ulceration. Affected babies are usually difficult to feed cry a lot through out the day and night (in contrast to babies with infant COLIC, whose crying is usually confined to the afternoons and evenings). and may fail to gain weight or even lose it. Any baby who regularly, vomits large amounts or does not gain weight at the expected rate should be medically investigated so that the cause (and there are many possibilities) can be discovered and corrected. Babies found to have reflux oesophagitis generally improve dramatically with prescribed medication.