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Friday, February 8, 2008

What is the difference between reflux, GERD, reflux esophagitis and heartburn?

Reflux: gastric juices containing acid from the stomach leaks up into the esophagus particularly after meals when the lower esophageal sphincter (LES) opens. When reflux occurs acid induces a secondary peristaltic contraction of the smooth muscle of the esophagus and it returns approximately 90% of the acid and food to the stomach within a few seconds. The remaining acid in the esophagus is neutralized by successive swallows of alkaline saliva. Once a peristalsis ends, the LES closes again. Most episodes of reflux are asymptomatic.

GERD: stands for gastroesophageal reflux disease and is a medical condition when the reflux of gastric juices causes troublesome symptoms or complications. Reflux can cause a burning feeling rising from the stomach or lower chest up towards the neck. This is known as heartburn.

Reflux esophagitis: the inner lining of esophageal wall may be damaged by prolonged exposure to stomach acid. This is known as reflux esophagitis. Many patients with GERD have a normal esophagus on endoscopy. The first sign of esophageal damage may be the reddness or friability of the inner lining of esophagus (called mucosa) indicating inflammation. Appearance of erosions (a shallow open sore limited to the mucosa) indicates more severe disease. Esophageal ulcers (a deep open sore) can also occur to the more common erosions.

Is there a risk of cancer?
Severe, long-standing GERD can damage the esophagus and cause a condition known as Barrett’s esophagus where the normal lining of the esophagus is replaced by a lining more like that of the stomach or intestine. It is thought that this replacement may be an attempt by the body to protect itself from further injury by acid. The risk of esophageal cancer appears to increase significantly in patients with Barrett’s esophagus. The only way to diagnose Barrett’s esophagus is by endoscopy. Some studies suggest that intensive treatment of Barrett’s esophagus with effective acid suppression can reduce the amount of abnormal lining in the esophagus. It is not clear whether such treatment will prevent esophageal cancer, but this is under active investigation.

Barrett's esophagus

Figure 1: Barrett's esophagus

Can I go on holiday?
Many of the activities that we do on holiday can make GERD worse. These include overeating, drinking too much alcohol, eating late at night. If you suffer from GERD, you should try to follow the same precautions as you do at home. It may be worth talking to your doctor before you go, so that you have a supply of medicine just in case you need relief. You may find it helps to use pillows to raise the head of the bed while sleeping.

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