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Gastroesophageal reflux disease and heartburn - Introduction

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of GERD.

Alternative Names

Heartburn; GERD

Introduction:

Gastroesophageal reflux disease (GERD) is a condition in which acids from the stomach flow back up into the esophagus (an action called reflux). Reflux occurs if the muscular actions in the esophagus or other protective mechanisms fail.

Heartburn
Click the icon to see an animation about heartburn.

The hallmark symptoms of GERD are:

Heartburn: a burning sensation in the chest and throat.
Regurgitation: a sensation of acid backed up in the esophagus.

Although acid is a primary factor in damage caused by GERD, other products of the digestive tract, including pepsin and bile, can also be harmful.

Heartburn is a condition in which the acidic stomach contents back up into the esophagus, causing pain in the chest area. This reflux usually occurs because the sphincter muscle between the esophagus and stomach is weakened. Remaining upright by standing or sitting up after eating a meal can help reduce the reflux that causes heartburn. Continuous irritation of the esophagus lining, as in gastroesophageal reflux disease, is a risk factor for developing esophageal cancer.

The Esophagus

The esophagus, commonly called the food pipe, is a narrow muscular tube about nine-and-a-half inches long. It begins below the tongue and ends at the stomach. The esophagus is narrowest at the top and bottom; it also narrows slightly in the middle.

The esophagus consists of three basic layers:

An outer layer of fibrous tissue.
A middle layer containing smoother muscle.
An inner membrane, which contains many tiny glands.

Esophagus
Click the icon to see an image of the esophagus.

When a person swallows food, the esophagus moves it into the stomach through the action of wave-like muscle contractions, called peristalsis. In the stomach, acid and various enzymes break down the starch, fat, and protein in food. The lining of the stomach has a thin layer of mucus that protects it from these fluids.

If acid and enzymes back up into the esophagus, however, its lining offers only a weak defense against these substances. Instead, several other factors protect the esophagus. The most important structure protecting the esophagus may be the lower esophageal sphincter (LES). The LES is a band of muscle around the bottom of the esophagus, where it meets the stomach.

After a person swallows, the LES opens to let food enter the stomach. It then closes immediately to prevent regurgitation of the stomach contents, including gastric acid.
The LES maintains this pressure barrier until food is swallowed again.

Stomach
Click the icon to see an image of the stomach.

If the pressure barrier is not enough to prevent regurgitation and acid backs up (reflux), peristaltic action of the esophagus serves as an additional defense mechanism, pushing the backed-up contents back down into the stomach.

Resources

http://digestive.niddk.nih.gov -- National Digestive Diseases Information Clearinghouse
www.gastro.org -- American Gastroenterological Association
www.acg.gi.org -- American College of Gastroenterology
www.asge.org -- American Society for Gastrointestinal Endoscopy
www.ssat.com -- Society for Surgery of the Alimentary Tract
www.naspgn.org -- North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
www.reflux.org -- Pediatric/Adolescent Gastroesophageal Reflux Association
www.iffgd.org -- International Foundation for Functional Gastrointestinal Disorders

References

Brant K. Oelschlager BK, Eubanks TR, Pellegrini CA. Hiatal Hernia and Gastroesophageal Reflux Disease. In: Townsend: Sabiston Textbook of Surgery, 18th ed. Philadelphia, PA:WB Saunders; 2007:chap 42.

Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Ann Surg. 2007;246(1):11-21.

Friedenberg FK, Xanthopoulos M, Foster GD, Richter JE. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111-2122.

Furnée EJ, Draaisma WA, Broeders IA, Smout AJ, Gooszen HG. Surgical reintervention after antireflux surgery for gastroesophageal reflux disease: a prospective cohort study in 130 patients. Arch Surg. 2008;143:267-274.

Gee DW, ANdreoli MT, Rattner DW. Measuring the effectiveness of laparoscopic antireflux surgery: long-term results. Arch Surg. 2008;143:482-487.

Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009;301:2120-2128.

Hirano I, Richter JE, and the Practice Parameters Committee of the American College of Gastroenterology. ACG practice guidelines: esophageal reflux testing. American Journal of Gastroenterology. 2007;102:668-685.

Islami F, Kamangar F. Helicobacter pylori and esophageal cancer risk: a meta-analysis. Cancer Prev Res. 2008;1:329-338.

Jeansonne LO, White BC, Nguyen V, Jafri SM, Swafford V, Katchooi M, et al. Endoluminal full-thickness plication and radiofrequency treatments for GERD: An outcomes comparison. Arch Surg. 2009;144:19-24.

Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391.

Jacobson BC, Moy B, Colditz GA, et al. Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux. Arch Intern Med. 2008;168(16):1798-1804.

Mishkin DS, Chuttani R, Croffie J, et al. ASGE Technology Status Evaluation Report: wireless capsule endoscopy. Gastrointestinal Endoscopy. 2008;63(4): 539-545.

Orenstein S, Peters J, Khan S, et al. Gastroesophageal Reflux Disease (GERD). In: Kliegman: Nelson Textbook of Pediatrics, 18th ed. Philadelphia, PA: WB Saunders; 2007:chap 320.

Rodriguez LG, Ruigómez A, Martin-Merino E, Johansson S, Wallander MA. Relationship between gastroesophageal reflux disease and COPD in UK primary care. Chest. 2008;1223-1230.

Talley NJ, Locke GR 3rd, McNally M, Schleck CD, Zinsmeister AR, Melton LJ 3rd. Impact of gastroesophageal reflux on survival in the community. Am J Gastroenterol. 2008;103:12-19.

Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Lesie WD. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ. 2008;179:319-326.

Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-97.

Wilson JF. In The Clinic: Gastroesophageal Reflux Disease. Ann Intern Med. 2008;149(3):ITC2-1-15.

Zhao Y, Encinosa W. Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005. Agency for Healthcare Research and Quality, January 2008.

Reviewed last on: 6/23/2009
Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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