Who has never felt an annoying tingling or burning sensation in the chest (heartburn)? Or is it an unpleasant sensation of fluid rising into the mouth (regurgitation)? What we usually simplify with the term “heartburn” are the typical symptoms of gastroesophageal reflux, which affects one in four adults at least once a week, according to a country study.
Is heartburn sometimes a problem? No. But chronically experiencing it can be a sign gastroesophageal reflux disease (GERD) which without proper diagnosis and treatment can lead to complications. And because it’s linked to rising risk factors like obesity and stress, gastroenterologists warn it’s on the rise, too.
This concern is evidenced by the requests received on the channel “Questions for a good life”: I am interested in learning about GERD. Is there a cure, is there a diet for life? Is it possible to regenerate the mucous membrane burned by silent reflux?
What is gastroesophageal reflux
Gastroesophageal reflux is the reflux of stomach contents into the esophagus. It can be produced in small amounts by physiological means. However duration time and frequency contact of stomach acid with the esophagus can cause symptoms or other complications, the Argentine Society of Gastroenterology (SAGE) determines.
The mechanism is as follows: the food we eat passes from the esophagus to the stomach through the lower esophageal sphincter, which opens to let the food through. After swallowing, this valve closes again. The problem is when it opens to miss reverse content.
It lies in the fact that one of the functions of the stomach in the process of digestion is the release of acid. The esophagus should not accept it because its walls are more delicate.
“Reflux occurs when these ‘little gates’ open, acid rises up into the esophagus and can (although not always) cause symptoms because it’s irritating, can hurt and cause complications,” he explained. Clarion Lisandro Pereira, gastroenterologist at the German Hospital.
The presence of symptoms alone is not enough to make a diagnosis of GERD, experts say, although it is enough to conduct a consultation with their recurrent course. In fact, there are people who do not show them or are less sensitive to them. Proper diagnosis is fundamental because not all patients are treated the same way.
Jorge Olmos, head of neurogastroenterology at the UBA Clinical Hospital, explains it this way: “The first thing to know is that reflux disease not synonymous with symptom. Many of those with symptoms are sensory, and these sensory patients are being treated with another drug,” he said.
Olmos led the Consensus on the Diagnosis of Gastroesophageal Reflux Disease, a document developed by a panel of experts from across the continent and published in 2022.
“Gastroesophageal reflux disease is very common throughout the world. Its incidence is increasing and in recent years there have been significant changes in its definition and classification. In turn, many new methodologies have emerged. For this reason, the goal we pursued was to conduct an exhaustive search for evidence to determine the usefulness of all of them at the diagnostic level,” said the former president of SAGE.
Why does gastroesophageal reflux occur?
There are many factors that can cause reflux, and many of them are on the rise, which is associated with an increase in GERD.
One age. With age, the force of contractions of the esophagus and the pressure on the sphincter decrease. This makes older people more prone to it. With an increase in life expectancy, the frequency of reflux also increases.
Modifiable risk factors include obesity and overweight.
“The more overweight we are, the more difficult it is for the sphincter to close because the diameter of the abdomen increases, it pushes up and causes acid levels to rise,” says Pereira. But this is not just a mechanical factor. “Obesity releases certain hormones that cause the ‘little door’ to open more often and allow acid to pass through.”
Also due to intra-abdominal pressure, pregnancy may contribute to reflux.
Except, certain foods called “irritants” They can make heartburn worse, such as foods high in fat, yerba yerba, coffee, spicy foods, citrus fruits (“and others that aren’t reported in the scientific evidence but may cause symptoms in some people,” Pereira said).
“On the other hand, there are some other factors that can increase the perception of heartburn, such as hypersensitivity at the level of the esophagus, which is closely related to emotional factors and stress“, said Maria Marta Piscorz, a neurogastroenterologist at the Hospital de Clínicas.
“Stress can generate more sensuality,” explained a gastroenterologist at the German Hospital. What does it mean? “That the receptors in our esophagus will be more alert to any release of acid and cause the sphincter to open more frequently. This gate performs a temporary relaxation and closes again to offset the pressure a little, but when these relaxations are too long can create a lot of acid.
Eat medicines which also increase erection, diseases such as scleroderma and behavior like go to bed immediately after eating. Smoking or excessive drinking They can also promote reflux.
people with hiatal hernia or hiatal hernia they are also more likely to suffer from it. This is a condition in which part of the stomach presses against the diaphragm muscle. Yes, right where the sphincter is.
“When it is very large, it can deform the sphincter closure and make it left ajaror. These cases are often difficult to treat with medication and habit changes. You can do an operation called a Nissen fundoplication, but we try to avoid it and save it only for cases where the hernia is very, very large, and we see that everything is going up, ”Pereira explained.
How is reflux diagnosed?
The diagnosis of GERD must be made by a doctor. The antecedents of a patient’s medical history and their symptoms are fundamental to the diagnostic presumption, states the SAGE.
And they indicate that the doctor may request additional studies if he deems it necessary as videoendoscopy of the upper gastrointestinal tract which will allow the disease to be classified based on the presence of esophageal disorders (mainly inflammation) and reflux studies such as phometry or impedancemetry.
Barrett’s esophagitis and esophagus
“Endoscopy is indicated to assess whether reflux caused complications in the esophagus, which are more common in patients who are obese, those who have reflux that has not subsided for many years, or when it starts in large quantities. Also in people who experience trouble swallowing or weight loss. And those who have a family history of esophageal or Barrett’s esophagus cancer,” Pereira said.
“When patients present with symptoms of reflux, such as frequent heartburn, i.e. burning in the chest, or fluid that returns to the mouth, about 20% have severe esophagitis, i.e. they have severe compromise by reflux of the esophageal mucosaOlms said.
Esophagitis is a condition in which the lining of the esophagus becomes swollen, inflamed, or irritated.
“It’s like a scratch. Patients with esophagitis should be closely monitored because this inflammation can turn into a scar, which is Barrett’s disease. cells for the stronger, intestinal ones,” Pereira added.
Barrett’s esophagus is a risk factor for esophageal cancer. “The risk is small, but the patient must be under control, manage it with a gastric protector and monitor it with endoscopy so it’s not progressing.”
Reflux treatment: is it curable?
In most cases, they respond well to hygiene and dietary measures, which include: lose weight and reduce belly fat in case of obesity, raise the head of the bed in patients with nocturnal symptoms and do not lie down immediately after eating.
With regard to dietary modification, it is assumed that the changes are individual for each patient. However, there are some foods that can be avoided in the first place, such as, fatty, fried, spicy, coffee, mate, citrus.
Erosive reflux disease responds well to a number of drugs, proton pump inhibitor, which are the most suitable drugs for the treatment of the disease. This group includes: omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole or dexlansoprazole as indicated by SAGE.
“These drugs have shown great efficacy. in resolving symptoms healing of the esophageal mucosa and elimination of complications.
“Treatment can be done in different ways. The drug, its dose and time of administration Your doctor will decide: starting with maximum doses and gradually reducing them or starting with low doses and increasing them; treatment can be prescribed for several years or on demand for several days, depending on the category of reflux, ”the medical society answers.
“Among those with true reflux disease, most of them respond to proton pump inhibitors with one molecule or another, and they work well. And for patients who are not helped by proton pump inhibitors, there are surgical treatments, fortunately, they are few. who needs it,” said Olmos.
As to whether GERD can be cured, he replied that “chronic diseases, which are the majority, require chronic treatment, or request (when symptoms worsen) or constantlydepending on the subtype of reflux in the patient.
With regard to the possibility of regeneration of the burnt mucosa, the experts explained that Treatment promotes healing.
Diet for life?
“Although there are some recommendations that are given for symptomatic patients (because there are those who have symptoms sporadically), diet it’s not what has the biggest impact with reflux disease. These patients are treated on demand, but for now, without much interference, they can do broader dietOlmos answered.
In the same vein, Pereira concluded that “Most patients respond to initial changes in acid reduction with pharmacological treatment, changing habits, and identifying and suppressing certain foods that may cause reflux for a while.” But You don’t have to avoid them all your life.“.
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