Gastroesophageal Reflux Disease (GERD)

[AnGe|ic]

*Definition:
Gastroesophageal Reflux Disease is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.
This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter (LES), transient LES relaxation, impaired expulsion of gastric reflux from the esophagus.

*Causes:
-LES relaxation ( due 2 use of calcium blockers, nitrates, oral contraceptives)
-mobility defect in the stomach

*Treatment:
1- Elevate head in bed
2-Eat 3 hrs before bedtime
3-Avoid chocolate, mint, and fatty food
4-Avoid lying down
5-Avoid tomato, coffee, citrus juices
6-Lose weight
7-Avoid tight-fitting clothes
8-Drugs
a- Antacids: Sodium bicarbonate, Ca, Al, Mg hydroxides
They increase the pH of gastric mucosa
b-Alginic Acid :
Alginic acid with sodium bicarbonate with saliva give Sodium Alginate which floats on surface of gastric mucosal contents and when refluxed lower irritation is observed

*Some foods to avoid:
Certain foods and lifestyle are considered to promote gastroesophageal reflux:

• Coffee, alcohol, and excessive amounts of Vitamin C supplements stimulate gastric acid secretion. Taking these before bedtime especially can cause evening reflux. Calcium containing antacids are in this group.
• Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these tends to help. Fat also delays stomach emptying.
• Having more but smaller meals also reduces GERD risk, as it means there is less food in the stomach at any one time.
• Eating shortly before bedtime (For clinical purposes, this usually means 2-3 hours before going to bed).
• Large meals.
• Soda or pop (regular or diet).
• Chocolate and peppermint.
• Acidic foods, such as oranges and tomatoes (however, they are okay when fresh).
• Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
• Milk and milk-based products contain calcium and fat, and should be avoided before bedtime.