GERD (Gastroesophageal Reflux Disease) is injury to the esophagus that develops from chronic exposure of the esophagus to acid coming up from the stomach (reflux). In contrast, heartburn is the symptom of acid in the esophagus, characterized by a burning discomfort behind the breastbone (sternum). Findings in GERD include esophagitis (reflux esophagitis) - inflammatory changes in the esophageal lining (mucosa), strictures, difficulty swallowing (dysphagia) and chronic chest pain. Patients may have only one of those findings. Atypical symptoms of GERD include cough, hoarseness, changes of the voice, and sinusitis. Complicatons of GERD include stricture formation, Barrett's esophagus, esophageal ulcers and possibly even to esophageal cancer.
Occasional heartburn is common but does not necessarily mean one has GERD. Patients that have heartburn symptoms more than once a week are at risk of developing GERD. A hiatal hernia is usually asymptomatic, but the presence of a hiatal hernia is a risk factor for development of GERD.
The most prominent symptom of gerd is heartburn, the sensation of burning pain in the chest coming upward towards the mouth caused by reflux of acidic contents from the stomach to the esophagus.
Patients with gerd also tend to get the feeling of a sour or salty taste at the back of their throats due to regurgitation. This can sometimes happen even if the pain of heartburn is absent.
Less common gerd symptoms include:
- Chest pain without any of the above
- Dysphagia (difficulty swallowing)
- Halitosis (bad breath)
- Regurgitation (vomit-like taste in the mouth)
- Repeated throat clearing
- Water brash (the sensation of a large amount of non-acid liquid due to sudden hypersecretion of saliva)
complications of gerd symptoms:
- Strictures or scarring of esophagus (especially young children).
- Barrett's esophagus (sometimes referred to as Barrett's Disease)
- Esophageal cancer
important warning symptoms of gerd:
- Trouble swallowing Dysphagia requires immediate medical attention
- Vomiting blood or partially digested blood (looks like coffee grounds) requires immediate medical attention as does digested blood in the stools.
GERD is commonly overlooked in infants and children. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems. Inconsolable crying, failure to gain adequate weight, refusing food and bad breath are also common. Children may have one symptom or many - no single symptom is universally present in all children with GERD.
Babies' immature digestive systems are usually the cause, and most infants stop having acid reflux by the time they reach their first birthday. Some children don't outgrow acid reflux, however, and continue to have it into their teen years. Children that have had heartburn that doesn't seem to go away, or any other symptoms of GERD for a while, should talk to their parents and visit their doctor.
A detailed history taking is vital to the diagnosis. Useful investigations may include barium swallow X-rays, esophageal manometry, esophageal pH monitoring and Esophagogastroduodenoscopy (EGD). In general, an EGD is done when the patient does not respond well to treatment, has had symptoms or required medications for a prolonged time (generally 5 years), has dysphagia, anemia, blood in the stool (detected chemically), has weight loss, or has changes in the voice.
Esophagogastroduodenoscopy (EGD) (a form of endoscopy) involves the insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surface of the esophagus, stomach and duodenum
Biopsies can be performed during gastroscopy and these may show:
- Edema and basal hyperplasia (non-specific inflammatory changes)
- Lymphocytic inflammation (non-specific)
- Neutrophilic inflammation (usually either reflux or Helicobacter gastritis)
- Eosinophilic inflammation (usually due to reflux)
- Goblet cell intestinal metaplasia or Barretts esophagus.
- Dysplasia or pre-cancer.
- Rapid testing assays can quickly detect the presence of Helicobacter pylori in a biopsy sample through urease testing.
Posted by Staff at May 23, 2005 8:50 PMblog comments powered by Disqus