Definition of "Reflux"

Last modified: 11 days



Gastroesophageal reflux disease (aka GERD) is a chronic disease where stomach acid comes up from the stomach into the esophagus, causing mucosal damage. Reflux is where this occurs in babies and young children, and is physiological.

Patient information

What is reflux?
It's where the contents of the stomach, comes up into the tube above, called the esophagus. It's a problem because the stuff in the stomach is quite acidic.

Pathophysiology
  • Caused by failure of the lower esophageal sphincter (i.e. barrier between the stomach and esophagus), whether permanent or temporary. It is caused by:
    • Abnormal relaxation in the lower esophageal sphincter (which normally holds the top of the stomach closed)
    • Impaired expulsion of gastric reflux from the esophagus
    • Hiatal hernia
    • Obesity
    • Zollinger-Ellison syndrome
    • High blood calcium, which can increase gastrin production, causing increased acidity
    • Scleroderm and esystemic sclerosis, which can cause esophageal dysmotility
    • Drugs, e.g. prednisolone
    • Visceroptosis or Glenard syndrome, where the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach
  • Normally, the Angle of His (i.e. angle at which the esophagus enters the stomach) creates a valve that prevents duodenal bile, enzymes and stomacha cid from travelling back into the esophagus, where it can cause burning/inflammation of sensitive esophageal tissue

Patient information

Wait. Is this normal? Isn't the body designed so stuff in the tummy, stays in the tummy?
It is. Usually the lower esophageal sphincter holds the stuff in the tummy, in the tummy. But if it relaxes, stuff can go up, out of the tummy.

You said that a hiatal hernia can also cause this. What is that? What is a hiatus? Isn't that where you take a break from something ?
We're talking about the esophageal hiatus there, which is the opening in the diaphragm, through which the esophagus passes from the chest into the tummy area. Hiatus hernia is where part of the tummy herniates into the thorax, through a weakness in the diaphragm.

Sx
  • Most commonly:
    • Regurgitation
    • Heartburn
  • Painful swallowing
  • Increased salivation
  • Nausea
  • Chest pain
  • Coughing

In kids:

  • Repeated vomiting
  • Effortless spitting up
  • Coughing, or other respiratory problems (e.g wheezing)
  • Inconsolable crying
  • Refusing food
  • Crying for feed, and then pulling off the bottle or breast only to cry for it again
  • Failure to gain adequate weight
  • Bad breath
  • Belching or burping
Dx
  • Sx
  • Short term Tx w/ PPI's, showing improvement in Sx, suggesting positive Dx
  • EGD (esophagogastroduodenoscopy)
  • Esophageal pH monitoring, the gold standard, allows monitoring GERD in pt's in their response to medical or surgical Tx
  • Barium swallow x-rays, should NOT be used for Dx
  • Esophageal manometry is NOT recommended for use in Dx being recommended only prior to surgery
  • Ix for H pylori is usually NOT needed
Tx
  • Lifestyle changes, including:
    • Weight loss
    • Elevating the head
    • Moderate exercise, improves Sx, although vigorous exercise may worsen Sx
    • Avoiding certain foods, especially before lying down, that promote GERD, although there is little evidence. Foods implicated include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods
    • Stopping smoking, and not drinking alcohol, do NOT appear to result in significant improvement in Sx
  • Medications, including:
    • Antacids (see page)
    • PPI's (proton pump inhibitors)
    • H2 blockers
  • Surgery, in those who don't improve, including:
    • Nissen fundoplication, where the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter, and prevent acid reflux, and to repair a hiatal hernia
    • LINX, involving a series of metal beeds w/ magnetic cores placed surgically around the lower esophageal sphincter
Epidemiology
  • Affects 10-20% of the population in the Western world

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Definition of Reflux | Autoprac


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