What You Must Know About Gastroesophageal Reflux Disease ?

The current conception of GERD is to include a family of conditions with the common characteristic that are caused by gastroesophageal reflux with consequent annoying symptoms or a series of possible esophageal and extra-esophageal manifestations. It is estimated that 10-15% of adults in the United States have GERD, although these estimates are based only on self-reported chronic heartburn population studies

Pathophysiology 

The best defined subgroup of patients with GERD, although overall a minority, have esophagitis. Esophagitis occurs when reflux gastric acid and pepsin cause necrosis of the esophageal mucosa causing erosion and ulcers. Note that some degree of gastroesophageal reflux is normal, physiologically in
tertwined with the belching mechanism (transient relaxation of the SLE), but esophagitis is the result of excessive reflux, often accompanied by a reduced clearance of the reflex gastric juice

The restriction of reflux to what is physiologically expected depends on the anatomical and physiological integrity of the esophagogastric junction, a complex sphincter that includes both the LES and the surrounding femoral diaphragm. Three dominant mechanisms of incompetence of the esophagogastric junction are recognized:

(1) Transient relaxation of LES (a vagovagal reflex in which gastric distension causes LES relaxation)

(2) Hypotension of LES 

(3) Anatomical distortion of the esophagogastric junction, including hiatal hernia

Transient relaxation of SLE accounts for approximately 90% of reflux in normal subjects or in patients with GERD without hiatal hernia, but patients with hiatal hernia have a more heterogeneous mechanistic profile

After acid reflux, peristalsis returns the fluid to reflux in the stomach and the acid clearance is completed by titrating the residual acid with bicarbonate contained in the ingested saliva. Consequently, two causes: impaired peristalsis and reduced salivation of prolonged acid clearance. Altered peristaltic emptying can be attributed to interrupted peristalsis or the superimposed reflux associated with a hiatal hernia

Signs and symptoms

The most common symptom of gastroesophageal reflux disease is heartburn, the painful burning sensation felt just behind the sternum. Many patients also have problems with swallowing and spitting, when materials from the stomach actually return to the mouth, while both nausea, chest pain, painful swallowing and excessive salivation are less common symptoms 

Symptoms can range from mild to severe and when gastroesophageal reflux disease begins to reach the severe end of the spectrum, you are at risk of real physical harm in addition to the pain and discomfort of chronic heartburn, including narrowing of the esophagus to cause of chronic inflammation and ulcers in the lining of the esophagus

Extraesophageal syndromes with a well-established association with GERD include chronic cough, laryngitis, asthma and dental erosions. A multitude of other cases  have proposed associations with GERD , such as pharyngitis, chronic bronchitis, pulmonary fibrosis, chronic sinusitis, cardiac arrhythmias, sleep apnea and recurrent aspiration pneumonia

However, in both cases, it is important to emphasize the word association rather than causality. In many cases, the disturbances probably coexist due to shared pathogenic mechanisms rather than strict causality. The potential mechanisms for the manifestations of extra-esophageal GER are regurgitation with direct contact between the reflux and the supra-oesophageal structures or through a vagovagal reflex in which the activation by reflux of the afferent esophageal nerves triggers efferent vagal reflexes such as bronchospasm, cough or arrhythmias

Heartburn: 

Heartburn refers to the burning sensation in the regions of the chest and stomach. It can be caused by the corrosive action of gastric acid on the walls of the esophagus. Pain usually starts in the abdomen and radiates to the neck region. In some cases, the sensation can be very acute and mimic angina or heart pain

Patients generally experience heartburn after meals. This is because acid reflux occurs more frequently after meals when food fills the stomach. Heartburn may also be more evident when the patient is in a sleeping position. Many people experience heartburn during sleep. If the pain is severe, it can interrupt sleep

Regurgitation: 

In some patients, acid reflux increases enough from the stomach to reach the mouth. In general, gastric acid only reaches the middle of the esophagus. However, when the volume of acid reflux is high, it can reach the mouth. Since the acid tastes bad, it causes a bad feeling in the mouth. The patient will suddenly find his mouth full of regurgitated gastric fluids. Frequent regurgitation can also cause tooth problems because the acid will destroy the tooth enamel

Nausea: 

Nausea is not a common symptom of GERD. However, it is more frequent in some patients. If unexplained nausea and vomiting occur, the cause may be gastroesophageal reflux disease

In some cases, acid reflux can cause breathing problems. This condition is known as laryngopharyngeal reflux or extraesophageal reflux disease. Unlike GERD, this condition does not cause heartburn, which is why it is also known as "silent reflux". Acid reflux can also cause dental problems, as acid reflux can enter the mouth and erode tooth enamel. It can also cause dental hypersensitivity