Saturday, April 28, 2012

Gastroesophageal Reflux Disease (GERD)


Gastroesophageal reflux disease (GERD), or acid reflux, is a condition that is a chronic problem for those affected by it. Common symptoms of GERD are heartburn (a burning feeling in the chest), a feeling of food being stuck behind your breast bone, nausea after eating a meal, a cough, a voice that is horse sounding or a sore throat. Symptoms can worsen at night when lying down. GERD is caused by stomach contents leaking back out of the stomach into the esophagus (the tube that carries food from the mouth to the stomach). Gastric or stomach acid, food and drink, and/or pepsin (a digestive enzyme that’s main function is to break down proteins that have been eaten) may leak out of the stomach. The impact of these substances on the lining of the esophagus can be harmful because they are caustic and the continuous back flow irritates the esophagus and can cause GERD.


Leaking is able to occur because the muscle fibers that form a ring at the base of the esophagus, called the lower esophageal sphincter (LES), do not close off the stomach completely from the esophagus. Therefore, leakage, or reflux can occur. Several factors can contributed to the occurrence of GERD including smoking, alcohol, drinking sodas, obesity, certain medicines, spicy food, eating big meals, eating prior to going to bed, eating too fast, etc.

GERD is one of the most common health problems that occur in adults in the United States. Also, it is not uncommon for infants to suffer from GERD. In babies it can be due to them having a poorly coordinated or under developed intestinal tract and they are otherwise healthy. However, some infants have GERD as a result of problems affecting their brain, nerves or muscles.

It is common for people with disabilities that prohibit them from feeding themselves to be affected by GERD. For those who have a congenital disability the cause of their GERD may relate to the basis of their disability. However, it can also be triggered by how they are being fed. This also applies to individuals who have an acquired disability. In many cases people who are fed are provided food too quickly, without time between bites to chew adequately and swallow. Therefore they swallow lumps of food that have not been chewed up into tiny pieces that will digest easily and can cause indigestion, which if occurs frequently can lead to GERD. Swallowing big lumps of food can also increase the risk of choking and/or aspiration. Additionally, many people who are fed are given too large a meal at one time, rather than smaller meals more frequently. This often is a result of limited time on the part of the care provider.

There are several ways of managing GERD. The first that is recommended is making lifestyle changes such as avoiding foods that cause problems, not eating for several hours before bed, not taking aspirins, etc. However, if lifestyle changes do not correct the problem there are several treatments that may be beneficial: medicine; surgery; or endoscopic treatments. There are three main groups of medicines used for treating GERD: antacids that neutralize the acid in the stomach; histamine type 2 receptor antagonists (H2RAs) that cause the stomach to make less acid; and, proton pump inhibitors (PPIs) that also cause the stomach to make less acid. PPIs are better at relieving heartburn and letting the esophagus heal than H2RAs.

For some people medicines do not control their reflux problems and surgery is a consideration. The surgery, called a fundoplication, takes the top part of the stomach and wraps it around the bottom of the esophagus and sews it in place. This reinforces the LES preventing reflux from occurring. This surgery is performed on children who have reflux problems that are severe enough to produce regular vomiting (in some cases several times a day) and for those who have erosion of the esophagus, or who are aspirating regularly.

The newest treatment for GERD is endoscopic treatment. It is not considered surgery as the treatment is conducted by putting an endoscope down the patient’s throat to perform the treatment. Because of the newness of this treatment there are not enough studies to know how well it works for the treatment of GERD.

For people who are unable to feed themselves, providing them a means to self feed such as a Mealtime Partner Dining System will often reduce or eliminate their GERD because it allows them to select the foods that they want to eat and control the pace and volume of food that they eat. For many individuals this is a simple solution to a chronic problem.

More information about GERD can be found in a report that reviewed 166 research studies on GERD. The report can be found at: www.effectivehealthcare.ahrq.gov/gerdupdate.cfm.
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