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All about acid reflux (AKA gastroesophageal reflux disease or GERD)

Statistics
It is estimated that over 160 million people suffer from acid reflux worldwide.
That includes 8.8 million Americans and 1.8 million Britons.

Studies have shown that:
20% of North Americans
Between 8.8%25.9% of Europeans
2.5%7.8% of East Asians,
8.7%33.1% of Middle Easterners,
11.6% of Australians
and 23.0% of South Americans suffer from acid reflux symptoms weekly.

Acid reflux impacts people of all types. Heredity, weight, and age do not factor into the
likelihood of suffering from it. Even children can get acid reflux.

A medical diagnosis of acid reflux is associated with a 57% increased risk of first heart
attack within 5 years.

Symptoms
The most common symptom is heartburn, but other symptoms include:
Regurgitation (vomiting)
Bad breath
Difficulty swallowing
Coughing and/or wheezing
Hoarseness, sore throat
Non-cardiac chest pain
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Tooth enamel erosion or other dental manifestations

Prevention
Treatment for acid reflux includes over the counter medicines, prescription drugs and
even surgery.

The following lifestyle changes have been also been recommended by the Mayo Clinic
and other top medical universities and clinics to help control the condition.
Maintain a healthy weight
Avoid acidic food and drinks (alcohol, coffee, tomatoes, etc.)
Eat small, frequent meals rather than large meals
Wait 3 hours after a meal to lie down
Elevating the head of your bed 6 - 8 inches by using a bed wedge pillow
Stop smoking
Avoid increased abdomen pressure; loosen that belt or stop doing sit-up exercises




Information

- What is acid reflux?
Acid reflux occurs when stomach acid flows back up into the esophagus the tube
which moves food down from the mouth to the stomach.
The stomach lining is specially adapted to produce this acid and also to protect itself
against its own corrosive secretion but the higher gut is not protected.
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The gastro esophageal sphincter (a ring of muscle) acts as a valve by closing the
entrance of the stomach and when it fails the symptoms of acid reflux such as heartburn
are felt. This is known as dyspepsia, pyrosis or acid indigestion.
- What causes acid reflux and gastroesophageal reflux disease?
Acid reflux is common in people of all ages and we can all experience it at some time. It
is often associated with what we eat or drink but sometimes there are no reasons
(idiopathic). Recurrent reflux that leads to disease has other causes & risk factors are
termed gastro esophageal reflux disease aka GERD or GORD.

An anatomical abnormality, known as a hiatal (or hiatus) hernia allows the upper
part of the stomach to enter the chest cavity, by letting it push up through the
diaphragm - this sometimes can lead to GERD.

Pregnancy can increase the occurrence and severity of the symptoms of dyspepsia
and the likelihood is increased furthermore if one suffered from acid reflux before
pregnancy.

Controllable lifestyle factors that can be changed include; obesity (over weight),
smoking, high table salt intake, a diet lacking fibre, little or no exercise.

- Tests and diagnosis of gastroesophageal reflux disease

1) Endoscopy Camera Imaging Upper gastrointestinal endoscopy (aka
esophago-gastro-duodenoscopy or EGD) visual inspection using a tube
containing an optical system. Can highlight, ulcers, strictures, Barrett's and an
inflamed esophagus but does not
diagnose GERD.

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2) X-ray Barium swallow radiograph (esophagram) ; by swallowing a barium
solution x-rays to be taken that can but not always identify structural damage
to the esophagus.

3) Biopsy normally dependent on EGD results and the biopsy & can be carried
out at the same. Tissue samples are removed from the esophagus lining for
lab analysis that can identify more serious underlying issues such as
infections & abnormalities.

4) pH monitoring measures the amount of acid (acidity testing).

5) Oesophageal manometry - can check the function of the oesophagus and lower
oesophageal sphincter.

6) Impedance monitoring - measuring rate of fluid movement along the oesophagus


Long term risks
Untreated acid reflux and long-term exposure to the stomach acid can damage the
esophagus leading to;

Esophagitis the damaged esophagus lining may cause irritation, bleeding &
ulceration.
Strictures - acid damage can lead to scarring which may make swallowing difficult
and issues with food getting stuck as it travels down the esophagus
Barrett's oesophagus - a serious complication in which changes in the oesophagus
make its lining resemble that of the intestine further down the gut.
Both esophagitis and Barrett's esophagus are associated with a higher risk of
cancer!



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Popular Medication types
There are countless over the counter none prescriptive medications. People with
persistent symptoms should always seek professional advice.

Antacids counteract (neutralize) the acid in your stomach. Chewable tablets or
liquid form.
H2 blockers (aka histamine H2-receptor antagonists) reduce the amount of acid
produced by the cells in the lining of the acid. Can be effective as short-term on demand
relief. Over the counter and prescribed in stronger strengths.
PPIs (Proton pump inhibitors) reduce the production of acid by blocking the enzyme
in the wall of the stomach that produces acid. More effective and widely preferred than
H2 blockers for long term management. Over the counter and prescription versions.
Prokinetic medicines speed up the passage of food through the stomach.
Surgery In extreme cases an operation (normally performed by keyhole surgery) can
tighten the lower oesophagus to prevent acid leaking up from the stomach.





Sources used:
Burden of Gastrointestinal Disease in the United States: 2012 Update, Anne F. Peery et
al, 2012. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480553/
Gastroesophageal reflux among different racial groups in the United States, H.B. El-
Serag et al, 2004. Available online at http://www.ncbi.nlm.nih.gov/pubmed/15188164
Gastroesophageal Reflux Disease, Medscape, 2014. Available online at
http://emedicine.medscape.com/article/176595-overview
Gastroesophageal Reflux Disease (GERD), University of Michigan, Faculty Group
Practice, 2013
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GERD, The Mayo Clinic, 2012. Available online at http://www.mayoclinic.org/diseases-
conditions/gerd/basics/definition/con-20025201
GERD may boost risk of MI, GI & Hepatology News, 2014. Available online at
http://www.gihepnews.com/news/top-news/single-article/gerd-may-boost-risk-of-
mi/961221c1640f6450b79a643d5bc37ea4.html
Statistics by country for Gastroesophageal Reflux Disease, 2004. Available online at
http://www.rightdiagnosis.com/g/gerd/stats-country.htm
Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review,
Hsehm B. El-Serag, Stephen Sweet, Christopher C. Winchester and John Dent, 2013.
Available online at http://gut.bmj.com/content/early/2013/07/12/gutjnl-2012-
304269.short?rss=1

http://www.medicalnewstoday.com/articles/146619.php
Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in
adults. Bethesda, Maryland, US: National Institute of Diabetes and Digestive and
Kidney Diseases. Information published online Dyspepsia in Pregnancy Available
online at http://www.patient.co.uk/health/dyspepsia-in-pregnancy
Understanding heartburn and reflux disease.
Bethesda, Maryland, US: American Gastroenterological Association. Information
published online, Symptoms and procedures to diagnose GERD available online at
http://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/page6.htm

What is acid reflux disease Available online at http://www.webmd.com/heartburn-
gerd/guide/what-is-acid-reflux-disease

Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults
http://digestive.niddk.nih.gov/ddiseases/pubs/Gerd/

http://www.nhs.uk/conditions/antacid-medicines/Pages/Definition.aspx
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