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Reflux, acid reflux, gastroesophageal reflux, esophagitis

Gastroesophageal reflux: what is it?

To understand what gastroesophageal reflux is, we need to mention the functioning of our digestive system. Our digestive canal is, like everything else in the body, wonderfully designed. One of its main features is that it has a series of valves, which allow food and the products of its digestion to continue from the mouth, to the stomach, to the intestines without going back. Sometimes, however, these efficient but delicate mechanisms break down. This is what happens in gastroesophageal reflux disease.

Theesophagus, that long, thin conduit that connects the oral cavity with the stomach, is separated from the latter by a valve, the lower esophageal sphincter; this valve allows, on the one hand, the ingested food to remain inside the stomach to undergo gastric digestive processes; and, on the other hand, that the gastric contents, which are acidic, do not rise upward, irritating the esophagus and also the first airways and the oral cavity. However, it is possible for such a valve to fail. There can be several causes, but among them it is useful to mention, because of their importance,hiatal hernia (the ascending of the first portion of the stomach from the abdomen toward the chest),obesity, and even seemingly innocent lifestyle habits-for example, wearing tight pants or tightening the belt a lot... A Helicobacter pylori infection can also be a cause of gastroesophageal reflux.

gastroesophageal reflux, MRGE, gastroesophageal reflux disease, GERDWhen the lower esophageal sphincter fails, gastric contents can back up into the esophagus and even higher up into the airway or mouth. The main, very frequent consequence is a burning sensation in the upper, middle, part of the abdomen, or behind the sternum: this is retrosternal heartburn. Associated with it may be other symptoms, rarer but indicative of an aggravation of the disease: the presence of an acidic liquid, sometimes containing food fragments, in the mouth(regurgitation); the appearance of coughing for which a respiratory cause cannot be recognized; alterations in heart rhythm that do not depend on a disease of the heart. Patients often wake up with a wet pillow, an expression of regurgitation of gastric fluid, and to relieve symptoms they must sleep with multiple pillows or in a half-sitting position. 

Gastroesophageal reflux, hiatal hernia, jatal herniaEven in the absence of such severe symptoms, it must be remembered that the mucous membrane of the esophagus has no protective system toward the acidic contents of the stomach: therefore, its continuous and prolonged contact with gastric juices causes inflammation of the esophagus, called esophagitisIf this situation persists for a long time, there may be important consequences. The most serious is the transformation of the cells that make up the esophageal mucosa: these, under the continued and intense action of gastric juices, can take on the appearance of the cells that normally make up the mucosa of the stomach. This phenomenon, known as dysplasia, gives rise to what is known as Barrett's esophagus, which is a precancerous lesion, in the sense that it tends to evolve to give rise to the formation of esophageal cancer, a very serious condition, especially since it is usually diagnosed late, when not much can be done by then.

Therefore, patients who suffer from retrosternal heartburn or think they have symptoms that can be traced to gastroesophageal reflux disease should see their doctor who will prescribe the appropriate tests for diagnosis (gastroscopy, Rx of the first digestive tract with oral contrast medium, esophageal manometry and pHmetry, breath test, etc.) and schedule the appropriate therapies and clinical follow-ups over time.

Nutrition and gastroesophageal reflux

In the overall economy of gastroesophageal reflux treatment,nutrition takes on an important role. Eating the right foods in the correct way can help relieve symptoms. Some useful tips may be:

  • Have small and frequent meals; you should avoid eating a lot, because this can increase the gastroesophageal reflux, nutrition, hiatal herniapressure in the stomach and promote reflux: better to have a small meal every 3 to 4 hours 
  • Avoid eating just before going to bed or just after waking up 
  • Avoid eating quickly; this can lead to introducing air with food, which can make gastric digestion more difficult and increase both pressure inside the stomach and belching 
  • Chew well and long, so that saliva can properly play its role within the digestive process
  • Reduce intake of coffee, tea, chocolate, alcohol, vinegar, citrus fruits, acidic foods in general (e.g., green apples, some types of tomatoes...) and carbonated drinks
  • Some fruits, such as banana, avocado and papaya, neutralize the acid in the stomach and help improve the symptomatology

Acid reflux, gastroesophageal refluxThere are other simple general measures that can be taken to mitigate the symptoms of gastroesophageal reflux disease. Among them:

  • Quitting smoking
  • Sleeping with the head elevated, for example, using multiple pillows
  • Avoid eating in the 2 to 3 hours before sleeping at night
  • If you are used to the afternoon "nap," try sleeping in an armchair and not in bed
  • Do not wear clothes or belts that are too tight
  • If you are overweight, try to lose weight
  • In case you are taking medications, check with your doctor whether any of them may trigger or aggravate reflux symptoms

Gastroesophageal reflux surgery

In the presence of gastroesophageal reflux due to ahiatal hernia, surgery remains, when the indication criteria are met, the best treatment option. Ahiatal hernia is formed when the initial part of the stomach, normally contained in the abdomen, ascends into the chest through the esophageal hiatus of the diaphragm, or that orifice of the diaphragm-an important respiratory muscle that marks the boundary between the chest and abdomen-through which the end of theesophagus-that which contains the lower esophageal sphincter-enters the abdomen and enters the stomach. When this occurs, for a number of complex reasons in which pressure differences between the chest and abdomen also play a role, the lower esophageal sphincter stops functioning: the passage between esophagus and stomach opens and stomach contents can reflux into the esophagus. Surgery, known as funduplication according to Nissen o anti-reflux plastic, consists of relocating the stomacGastroesophageal reflux, Nissen, Nissen surgery, antireflux plasticor in the correct position, restore the esophageal hiatus of the diaphragm to its normal size, and construct a new valve to supplement the now lost function of the lower esophageal sphincter. The surgery is performed in laparoscopy, so it is minimally invasive for the patient, and requires hospitalization for a few days. In case of the presence of Barrett's esophagus, it was seen that the condition does not regress, but neither does it progress. 

The procedure must be performed by a team of surgeons with high skill in laparoscopic surgery and adequate experience in performing these procedures. The physicians of Cuccomarino, MD, from leading International Centers, can ensure their patients the best and most accurate approach to solving their gastroesophageal reflux problems.


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