Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or
liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the
stomach). This action can irritate the esophagus, causing heartburn and other symptoms.
Causes
When you eat, food passes from the throat to the stomach through the esophagus (also called the
food pipe or swallowing tube). Once food is in the stomach, a ring of muscle fibers prevents food
from moving backward into the esophagus. These muscle fibers are called the lower esophageal
sphincter, or LES.
If this sphincter muscle doesn't close well, food, liquid, and stomach acid can leak back into the
esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms, or it
can even damage the esophagus.
The risk factors for reflux include:
Alcohol (possibly)
Hiatal hernia (a condition in which part of the stomach moves above the diaphragm,
which is the muscle that separates the chest and abdominal cavities)
Obesity
Pregnancy
Scleroderma
Smoking
Heartburn and gastroesophageal reflux can be brought on or made worse by pregnancy and many
different medications. Such drugs include:
Anticholinergics (e.g., for seasickness)
Beta-blockers for high blood pressure or heart disease
Bronchodilators for asthma
Calcium channel blockers for high blood pressure
Dopamine-active drugs for Parkinson's disease
Progestin for abnormal menstrual bleeding or birth control
Sedatives for insomnia or anxiety
Tricyclic antidepressants
If you suspect that one of your medications may be causing heartburn, talk to your doctor. Never
change or stop a medication you take regularly without talking to your doctor.

Symptoms
More common symptoms are:
Feeling that food is stuck behind the breastbone
Heartburn or a burning pain in the chest (under the breastbone)
o Increased by bending, stooping, lying down, or eating
o More likely or worse at night
o Relieved by antacids
Nausea after eating
Less common symptoms are:
Bringing food back up (regurgitation)
Cough or wheezing
Difficulty swallowing
Hiccups
Hoarseness or change in voice
Sore throat
Exams and Tests
You may not need any tests if your symptoms are not severe.
If your symptoms are severe or they come back after you have been treated, one or more tests
may help diagnose reflux or any complications:
Esophagogastroduodenoscopy (EGD) is often used to find the cause and examine the
esophagus (swallowing tube) for damage. The doctor inserts a thin tube with a camera on
the end through your mouth. The tube is then passed into your esophagus, stomach, and
small intestine.
Barium swallow
Continuous esophageal pH monitoring
Esophageal manometry
A positive stool occult blood test may diagnose bleeding that is coming from the irritation in the
esophagus, stomach, or intestines.
Treatment
You can make many lifestyle changes to help treat your symptoms. Avoid foods that cause
problems for you. Making changes to your routine before you go to sleep may also help.
See Gastroesophageal reflux - discharge for more on managing your symptoms at home.
Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take
acetaminophen (Tylenol) to relieve pain. Take your medicines with plenty of water. When your
doctor gives you a new medicine, remember to ask whether it will make your heartburn worse.
You may use over-the-counter antacids after meals and at bedtime, although they do not last very
long. Common side effects of antacids include diarrhea or constipation.
Other over-the-counter and prescription drugs can treat GERD. They work more slowly than
antacids but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take
these drugs.
Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach
H2 blockers (antagonists) lower the amount of acid released in the stomach
Anti-reflux operations (fundoplication and others) may be an option for patients whose
symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms
should improve after surgery, but you may still need to take drugs for your heartburn.
There are also new therapies for reflux that can be performed through an endoscope (a flexible
tube passed through the mouth into the stomach).
Outlook (Prognosis)
Most people respond to lifestyle changes and medications. However, many patients need to
continue taking drugs to control their symptoms.
Possible Complications
Asthma
Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of
cancer)
Bronchospasm (irritation and spasm of the airways due to acid)
Chronic cough or hoarseness
Dental problems
Esophageal ulcer
Stricture (a narrowing of the esophagus due to scarring)
When to Contact a Medical Professional
Call your health care provider if symptoms worsen or do not improve with lifestyle changes or
medication.
Also call for any of the following symptoms:
Bleeding
Choking (coughing, shortness of breath)
Feeling filled up quickly when eating
Frequent vomiting
Hoarseness
Loss of appetite
Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)
Weight loss
Prevention
Follow heartburn prevention techniques to prevent GERD.
Alternative Names
Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia - GERD
















Esophageal atresia
Esophageal atresia is a disorder of the digestive system in which the esophagus does not develop
properly. The esophagus is the tube that normally carries food from the mouth to the stomach.
Causes
Esophageal atresia is a congenital defect, which means it occurs before birth. There are several
types. In most cases, the upper esophagus ends and does not connect with the lower esophagus
and stomach. The top end of the lower esophagus connects to the windpipe. This connection is
called a tracheoesophageal fistula (TEF). Some babies with TEF will also have other problems,
such as heart or other digestive tract disorders.
Other types of esophageal atresia involve narrowing of the esophagus, and may also be
associated with other birth defects.
Esophageal atresia occurs in about 1 out of 4,000 births.
Symptoms
Bluish coloration to the skin (cyanosis) with attempted feedings
Coughing, gagging, and choking with attempted feeding
Drooling
Poor feeding
Exams and Tests
Before birth, an ultrasound performed on the pregnant mother may show too much amniotic
fluid, which can be a sign of esophageal atresia or other blockage of the digestive tract.
The disorder is usually detected shortly after birth when feeding is attempted and the infant
coughs, chokes, and turns blue. As soon as the diagnosis is suspected, an attempt to pass a small
feeding tube through the mouth or nose into the stomach should be made. The feeding tube will
not be able to pass all the way to the stomach in a baby with esophageal atresia.
An x-ray of the esophagus shows an air-filled pouch and air in the stomach and intestine. If a
feeding tube has been inserted, it will appear coiled up in the upper esophagus.
Treatment
Esophageal atresia is considered a surgical emergency. Surgery to repair the esophagus should be
done quickly after the baby is stabilized so that the lungs are not damaged and the baby can be
fed.
Before the surgery, the baby is not fed by mouth. Care is taken to prevent the baby from
breathing secretions into the lungs.
Outlook (Prognosis)
An early diagnosis gives a better chance of a good outcome.
Possible Complications
The infant may breathe saliva and other fluids into the lungs, causing aspiration pneumonia,
choking, and possibly death.
Other complications may include:
Feeding problems
Reflux (the repeated bringing up of food from the stomach) after surgery
Narrowing (stricture) of the esophagus due to scarring from surgery
Prematurity may complicate the condition.
When to Contact a Medical Professional
This disorder is usually diagnosed shortly after birth.
Call your baby's health care provider if the baby vomits repeatedly after feedings, or if the baby
develops breathing difficulties.
Alternative Names
Tracheoesophageal fistula







Achalasia
Achalasia is a disorder of the tube that carries food from the mouth to the stomach (esophagus),
which affects the ability of the esophagus to move food toward the stomach.
Causes
A muscular ring at the point where the esophagus and stomach come together (lower esophageal
sphincter) normally relaxes during swallowing. In people with achalasia, this muscle ring does
not relax as well. The reason for this problem is damage to the nerves of the esophagus.
Cancer of the esophagus or upper stomach and a parasite infection that causes Chagas disease
may have symptoms like those of achalasia.
Achalasia is a rare disorder. It may occur at any age, but is most common in middle-aged or
older adults. This problem may be inherited in some people.
Symptoms
Backflow (regurgitation) of food
Chest pain, which may increase after eating or may be felt in the back, neck, and arms
Cough
Difficulty swallowing liquids and solids
Heartburn
Unintentional weight loss
Exams and Tests
Physical examination may show signs of anemia or malnutrition.
Tests include:
Esophageal manometry
Esophagogastroduodenoscopy
Upper GI x-ray
Treatment
The approach to treatment is to reduce the pressure at the lower esophageal sphincter. Therapy
may involve:
Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any
benefit wears off within a matter of weeks or months.
Medications, such as long-acting nitrates or calcium channel blockers, which can be used to
relax the lower esophagus sphincter
Surgery (called an esophagomyotomy), which may be needed to decrease the pressure in the
lower sphincter
Widening (dilation) of the esophagus at the location of the narrowing (done during
esophagogastroduodenoscopy)
Your doctor can help you decide which treatment is best for your situation.
Outlook (Prognosis)
The outcomes of surgery and nonsurgical treatments are similar. Sometimes more than one
treatment is necessary.
Possible Complications
Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux)
Breathing food contents into the lungs, which can cause pneumonia
Tearing (perforation) of the esophagus
When to Contact a Medical Professional
Call your health care provider if:
You have difficulty swallowing or painful swallowing
Your symptoms continue even with treatment for achalasia
Prevention
Many of the causes of achalasia are not preventable. However, treatment of the disorder may
help to prevent complications.
Alternative Names
Esophageal achalasia