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Gastrointestinal Tract

Gastroesophageal reflux disease, acid reflux or GERD, is classified by the liquid within one's stomach that is regurgitated and sent back into the esophagus. The lining of the esophagus can be inflamed and damaged due to the liquid that backs up, or refluxes. Inflammation is only found in some patients; however this chronic condition is normally life-long. If injury is caused along the lining of the esophagus, this is an additional chronic condition. The refluxed liquid contains pepsin, an enzyme that is in charge of digestion in the stomach, and acids that are produced within the stomach. Furthermore, this liquid may contain bile that has been forced back into the stomach. The acid that is within the liquid is certainly the most harmful ingredient, although the pepsin and bile still injure the esophagus. Treatment can heal the esophagus, but once treatment is abandoned, the injury will return within a few months. As usual, treatment's help patients in different ways, depending on their condition.

Something to keep in mind is that mild reflux of stomach liquid does occur in most individuals. Interestingly, these individuals might even have the reflux as many times as a GERD patient experiences it. The difference is that patients have more acid in their stomach liquid. The acid will remain in the esophagus longer, and will travel higher, causing more damage. Luckily, there are body mechanisms that are in place to help neutralize and simply keep the body healthy. These include the salivary glands and the combination of swallowing in an upright position. The salivary glands are in place in order to secrete saliva. Composed of bicarbonate, saliva allows for a neutralization of the acid in the esophagus. Furthermore, as swallowing is continued throughout the day, the gravitation of the saliva will travel into the stomach, bringing the stomach liquid back into the stomach as well. Obviously at night time, gravity is no longer in effect when a person is sleeping, so saliva is no longer released at high levels. Reflux occurs at a much higher rate and sits in the esophagus causing damage that can't be reversed until treatment is introduced.

Interestingly, gastroesophageal reflux disease is a major issue throughout a woman's pregnancy, due to abnormal hormone levels that lower the pressure of the esophageal sphincter. Another factor to take note of is the increase of pressure on the abdomen that a growing fetus has. Together, the hormone levels and the growing fetus pressure will surely affect reflux. Other components may include disease such as mixed connective tissue diseases or scleroderma, which weaken the esophageal muscles and are prone to developing GERD.

A simple run down of causes include patients that simply produce excess amounts of acid, although this is not very common. Other causes are made up of issues with hiatal hernias, esophageal contractions, the lower esophageal sphincter and the emptying of the stomach. In the majority of patients, symptoms such as heartburn, nausea and regurgitation are common. In terms of complicated symptoms and issues with GERD, ulcers, inflammation of lungs, throat or larynx, Barrett's esophagus, coughing, asthma, fluid within sinuses and strictures are all possible and relatively common in patients.

As a patient, the symptoms to think about are a burning sensation in the middle of the chest. This can occur after a meal and can increase when lying down. Medications and treatments will be determined by a doctor once a thorough evaluation has been completed. The diagnosis will allow for a treatment plan to be devised. For starters, doctors try a simple medication to suppress the acid produced within the stomach. Upper gastrointestinal endoscopies are a test that is used to diagnose GERD. This is done by sending an optical system into the gastrointestinal tract and will allow for an in depth examination of the duodenum (part of intestine), the stomach and the lining of the esophagus. Doctors will then learn if the esophagus is inflamed, or they will need to check for other symptoms. The endoscopy will not guarantee a diagnosis of GERD, however it will help to identify different things such as erosions or ulcers in the lining of the esophagus. Other ways to learn if a patient has GERD would be through an x-ray, a biopsy, acid tests or throat and larynx examinations.

The best treatment would be to change and modify the patient's lifestyle and diet. However, this may be difficult and not followed by many patients. Sometimes, medications are a better and more worthwhile plan, considering they can be maintained more easily than a diet change.

Medications and drugs range from mild to severe capabilities in terms of effectiveness. Cimetidine, or Tagamet, is a histamine antagonist that has been designed for convenience and efficient use. This medication will work to prevent the acid-producing cells within the stomach. Another way to inhibit gastric acid secretion is through a proton pump inhibitor. Other drugs include sucralfate, which is useful in preventing damage in the esophagus, and different prokinetics, which are used to increase the rate of gastric emptying and also help strengthen the lower esophageal sphincter. All in all, treatments that contain antacids, histamine antagonists and then proton pump inhibitors, are effective in about seventy percent of patients, after about six months.

If gastroesophageal reflux disease is overriding the drugs previously described, surgical procedures, such as fundoplication, is used to prevent reflux. GERD can be maintained and treated, however it is important to see a doctor for a proper diagnosis and an individual treatment plan.