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Gastroesophageal reflux disease

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Gastroesophageal reflux disease
Other namesBritish: Gastro-oesophageal reflux disease (GORD);[1] gastric reflux disease, acid reflux disease, reflux, gastroesophageal reflux
X-ray showing radiocontrast from the stomach (white material below diaphragm) entering the esophagus (three vertical collections of white material in the mid-line of the chest) due to severe reflux
Pronunciation
SpecialtyGastroenterology
SymptomsTaste of acid, heartburn, bad breath, chest pain, breathing problems[5]
ComplicationsEsophagitis, esophageal strictures, Barrett''s esophagus.[5]

Risk factors include obesity, pregnancy, smoking, hiatal hernia, and taking certain medicines.[5] Medications involved may include antihistamines, calcium channel blockers, antidepressants and sleeping pills.[5] Acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the stomach and the esophagus.[5] Diagnosis among those who do not improve with simpler measures may involve gastroscopy, upper GI series, esophageal pH monitoring, or esophageal manometry.[5]

Treatment options include lifestyle changes; medications; and sometimes surgery for those who do not improve with the first two measures.[5] Lifestyle changes include not lying down for three hours after eating, raising the head of the bed, losing weight, avoiding foods which result in symptoms, and stopping smoking.[5] Medications include antacids, H2 receptor blockers, proton pump inhibitors, and prokinetics.[5][8]

In the Western world, between 10 and 20% of the population is affected by GERD.[8] Occasional gastroesophageal reflux without troublesome symptoms or complications is even more common.[5] The classic symptoms of GERD were first described in 1925, when Friedenwald and Feldman commented on heartburn and its possible relationship to a hiatal hernia.[9] In 1934 gastroenterologist Asher Winkelstein described reflux and attributed the symptoms to stomach acid.[10]

Contents

  • 1 Signs and symptoms

    ChildrenDrip gerd nasal post Foods To Avoid (🔥 10 Foods) | Drip gerd nasal post Heartburn Remedieshow to Drip gerd nasal post for [edit][edit]

    GERD may be difficult to detect in infants and children, since they cannot describe what they are feeling and indicators must be observed. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again, failure to gain adequate weight, bad breath, and burping are also common. Children may have one symptom or many; no single symptom is universal in all children with GERD.

    Drip gerd nasal post Naturally Treat (👍 Heartburn Remedies) | Drip gerd nasal post Remedy Reliefhow to Drip gerd nasal post for Of the estimated 4 million babies born in the US each year, up to 35% of them may have difficulties with reflux in the first few months of their lives, known as ''.[14] One theory for this is the "" which notes most animals are born with significant mobility, but humans are relatively helpless at birth, and suggests there may have once been a fourth trimester, but children began to be born earlier, evolutionarily, to accommodate the development of larger heads and brains and allow them to pass through the birth canal and this leaves them with partially undeveloped digestive systems.[citation needed]

    Most children will outgrow their reflux by their first birthday. However, a small but significant number of them will not outgrow the condition. This is particularly true when a family history of GERD is present.[Drip gerd nasal post Diagnosis (☑ Disease Treatment) | Drip gerd nasal post Best Home Remedieshow to Drip gerd nasal post for citation needed]

    Drip gerd nasal post 12 Tips (👍 Natural Remedies) | Drip gerd nasal post Heartburn Remedieshow to Drip gerd nasal post for Barrett''s esophagus

GERD may lead to Barrett''s to dysplasia is uncertain, but is estimated at about 20% of cases.[15] Due to the risk of chronic heartburn progressing to Barrett''s esophagus is seen.[26] Investigation for H. pylori is not usually needed.[26]

The current gold standard for diagnosis of GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and allows monitoring GERD patients in their response to medical or surgical treatment. One practice for diagnosis of GERD is a short-term treatment with proton-pump inhibitors, with improvement in symptoms suggesting a positive diagnosis. Short-term treatment with proton-pump inhibitors may help predict abnormal 24-hr pH monitoring results among patients with symptoms suggestive of GERD.[28]

Endoscopy[edit]

Endoscopy, the looking down into the stomach with a fibre-optic scope, is not routinely needed if the case is typical and responds to treatment.[26] It is recommended when people either do not respond well to treatment or have alarm symptoms, including dysphagia, anemia, blood in the stool (detected chemically), wheezing, weight loss, or voice changes.[26] Some physicians advocate either once-in-a-lifetime or 5- to 10-yearly endoscopy for people with longstanding GERD, to evaluate the possible presence of dysplasia or Barrett''s esophagus

  • Elongation of the papillae
  • Thinning of the squamous cell layer
  • Dysplasia
  • Carcinoma
  • Reflux changes may not be erosive in nature, leading to "".

    Severity[edit]

    Drip gerd nasal post Home Remedy (🔥 Treatment For) | Drip gerd nasal post 12 Tipshow to Drip gerd nasal post for Severity may be documented with the Johnson-DeMeester''s shoulders and head, may inhibit GERD when lying down.[36] Although moderate exercise may improve symptoms in people with GERD, vigorous exercise may worsen them.[33]

    Abstinence from smoking or alcohol does not appear to significantly relieve symptoms.[35]

    Medications for 1 last update 2020/08/11 [[edit]

    The primary medications used for GERD are proton-pump inhibitors, H2 receptor blockers and antacids with or without alginic for 1 last update 2020/08/11 acid.[8] The use of acid suppression therapy is a common response to GERD symptoms and many people get more of this kind of treatment than their case merits.[37] The overuse of acid suppression is a problem because of the side effects and costs.[37] The primary medications used for GERD are proton-pump inhibitors, H2 receptor blockers and antacids with or without alginic acid.[8] The use of acid suppression therapy is a common response to GERD symptoms and many people get more of this kind of treatment than their case merits.[37] The overuse of acid suppression is a problem because of the side effects and costs.[37]

    Proton-pump inhibitors[edit]

    Proton-pump inhibitors (PPIs), such as omeprazole, are the most effective, followed by H2 receptor blockers, such as ranitidine.[27] If a once daily PPI is only partially effective they may be used twice a day.[27] They should be taken one half to one hour before a meal.[26] There is no significant difference between PPIs.[26] When these medications are used long term, the lowest effective dose should be taken.[27] They may also be taken only when symptoms occur in those with frequent problems.[26] H2 receptor blockers lead to roughly a 40% improvement.[38]

    Antacids[editDrip gerd nasal post Disease Treatment (🔴 Foods That Fight Hearbturn) | Drip gerd nasal post 7 Natural GERDhow to Drip gerd nasal post for ]

    The evidence for antacids is weaker with a benefit of about 10% (NNT=13) while a combination of an antacid and alginic acid (such as Gaviscon) may improve symptoms 60% (NNT=4).[38] Metoclopramide (a prokinetic) is not recommended either alone or in combination with other treatments due to concerns around adverse effects.[8][27] The benefit of the prokinetic mosapride is modest.[8]

    Other agents[edit]

    Sucralfate has a similar effectiveness to H2 receptor the 1 last update 2020/08/11 blockers; however, sucralfate needs to be taken multiple times a day, thus limiting its use.[8] Baclofen, an agonist of the GABAB receptor, while effective, has similar issues of needing frequent dosing in addition to greater adverse effects compared to other medications.[8] Sucralfate has a similar effectiveness to H2 receptor blockers; however, sucralfate needs to be taken multiple times a day, thus limiting its use.[8] Baclofen, an agonist of the GABAB receptor, while effective, has similar issues of needing frequent dosing in addition to greater adverse effects compared to other medications.[8]

    Drip gerd nasal post Diagnosis (☑ Natural Remedies For) | Drip gerd nasal post Heartburn Reliefhow to Drip gerd nasal post for Surgery[edit]

    Drip gerd nasal post To Avoid (👍 Without Medication) | Drip gerd nasal post 10 Foods To Eathow to Drip gerd nasal post for The standard surgical treatment for severe GERD is the Nissen fundoplication. In this procedure, 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.[39] It is recommended only for those who do not improve with PPIs.[26] Quality of life is improved in the short term compared to medical therapy, but there is uncertainty in the benefits over surgery versus long-term medical management with proton pump inhibitors.[40] When comparing different fundoplication techniques, partial posterior fundoplication surgery is more effective than partial anterior fundoplication surgery,[41] and partial fundoplication has better outcomes than the 1 last update 2020/08/11 total fundoplication.[42] The standard surgical treatment for severe GERD is the Nissen fundoplication. In this procedure, 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.[39] It is recommended only for those who do not improve with PPIs.[26] Quality of life is improved in the short term compared to medical therapy, but there is uncertainty in the benefits over surgery versus long-term medical management with proton pump inhibitors.[40] When comparing different fundoplication techniques, partial posterior fundoplication surgery is more effective than partial anterior fundoplication surgery,[41] and partial fundoplication has better outcomes than total fundoplication.[42]

    Esophagogastric dissociation is an alternative procedure that is sometimes used to treat neurologically impaired children with GERD.[43][44] Preliminary studies have shown it may have a lower failure rate[45] and a lower incidence of recurrent reflux.[44]

    In 2012 the FDA approved a device called the LINX, which consists of a series of metal beads with magnetic cores that are placed surgically around the lower esophageal sphincter, for those with severe symptoms that do not respond to other treatments. Improvement of GERD symptoms is similar to those of the Nissen fundoplication, although there is no data regarding long-term effects. Compared to Nissen fundoplication procedures, the procedure has shown a reduction in complications such as gas bloat syndrome that commonly occur.[46] Adverse responses include difficulty swallowing, chest pain, vomiting, and nausea. Contraindications that would advise against use of the device are patients who are or may be allergic to titanium, stainless steel, nickel, or ferrous iron materials. A warning advises that the device should not be used by patients who could be exposed to, or undergo, magnetic resonance imaging (MRI) because of serious injury to the patient and damage to the device.[47]

    In those with symptoms that do not improve with PPIs surgery known as transoral incisionless fundoplication may help.[48] Benefits may last for up to six years.[49]

    Special populationsDrip gerd nasal post Quick Relief (☑ Home Remedies For) | Drip gerd nasal post Stops Acid Refluxhow to Drip gerd nasal post for [edit]

    Pregnancy[edit]

    In pregnancy, dietary modifications and lifestyle changes may be attempted, but often have little effect. Calcium-based antacids are recommended if these changes are not effective. Aluminum- and magnesium hydroxide -based antacids are also safe, as is ranitidine[50] and PPIs.[26]

    Drip gerd nasal post Nighttime (⭐️ Breakfast For) | Drip gerd nasal post Holidayhow to Drip gerd nasal post for the 1 last update 2020/08/11 BabiesBabies[edit]

    Babies may see relief with smaller, more frequent feedings, more frequent burping during feedings, holding baby in upright position 30 minutes after feedings, keep baby''gastrooesophageal reflux''s Esophagus. Retrieved on 1 February 2009.

  • ^ "". June 2009. Archived from the original on 9 September 2017.
  • Drip gerd nasal post Disease (🔥 Acid Reflux) | Drip gerd nasal post The Discomforthow to Drip gerd nasal post for ^^ Sontag SJ (1999). "". Yale J Biol Med. 72 (2–3): 69–80. PMC Drip gerd nasal post Natural Remedies For (🔴 How To Naturally Treat) | Drip gerd nasal post Naturally Treathow to Drip gerd nasal post for 2579007. PMID 10780568.
  • ^ Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "". Am J Gastroenterol. 102 (10): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791.
  • ^ Ayazi S; Crookes PF; Peyre CG; et al. (2007). "". Am J Gastroenterol. 102 (S2): 138–9. doi:10.1111/j.1572-0241.2007.01491_1.x. PMID 17767580. Archived from the original on 4 February 2011.
  • ^ Ayazi S, Hagen JA, Chan LS, DeMeester SR, Lin MW, Ayazi A, Leers JM, Oezcelik A, Banki F, Lipham JC, DeMeester TR, Crookes PF (August 2009). "". J. Gastrointest. Surg. 13 (8): 1440–7. doi:10.1007/s11605-009-0930-7. PMC 2710497. PMID 19475461.
  • ^ Drip gerd nasal post Other Natural Remedies (🔥 10 Drinks To Avoid) | Drip gerd nasal post Soothe The Painhow to Drip gerd nasal post for Morse CA, Quan SF, Mays MZ, Green C, Stephen G, Fass R (2004). "". Clin. Gastroenterol. Hepatol. 2 (9): 761–8. doi:10.1016/S1542-3565(04)00347-7. PMID 15354276.Drip gerd nasal post Home Remedies For (☑ Home Remedies For) | Drip gerd nasal post Foods To Eat And Avoidhow to Drip gerd nasal post for
  • ^ Kasasbeh A, Kasasbeh E, Krishnaswamy G (2007). "". Sleep Med Rev. 11 (1): 47–58. doi:10.1016/j.smrv.2006.05.001. PMID 17198758.
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  • ^ Mills, S (ed.) 2009.Sternberg''Oglio, L. (May 2001). "". Journal of Pediatric Surgery. 36 (5): 677–680. doi:10.1053/jpsu.2001.22935. ISSN 0022-3468. PMID 11329564.
  • ^ a b Morabito, Antonio; Lall, Anupam; Piccolo, R. Lo; McCarthy, Helen; Kauffmann, Lisa; Ahmed, Shiban; Bianchi, Adrian (May 2006). "". Journal of Pediatric Surgery. 41 (5): 919–922. doi:10.1016/j.jpedsurg.2006.01.013. ISSN 0022-3468. PMID 16677883.
  • ^ Goyal, Anju; Khalil, Basem; Choo, Kelvin; Mohammed, Khalid; Jones, Matthew (June 2005). "". Journal of Pediatric Surgery. 40 (6): 915–919. doi:10.1016/j.jpedsurg.2005.03.004. ISSN 0022-3468. PMID 15991170.Drip gerd nasal post Other Natural Remedies (🔴 Acid Reflux) | Drip gerd nasal post 10 Home Remedieshow to Drip gerd nasal post for for 1 last update 2020/08/11
  • ^ Badillo, Raul (2014). "". World Journal of Gastrointestinal Pharmacology and Therapeutics. 5 (3): 105–12. doi:10.4292/wjgpt.v5.i3.105. PMC 4133436. PMID 25133039.Drip gerd nasal post Heartburn Relief (🔥 Symptoms) | Drip gerd nasal post Diagnosishow to Drip gerd nasal post for
  • ^ Medical Device Approvals: LINX™ Reflux Management System - P100049 Archived 10 November 2013 at the Wayback Machine, U.S. Food and Drug Administration, U.S. Department of Health and Human Services, Update of 17 January 2014
  • Drip gerd nasal post Heartburn Symptoms (🔴 Heartburn During Pregnancy) | Drip gerd nasal post Best Home Remedieshow to Drip gerd nasal post for ^ Jain, D; Singhal, S (March 2016). "". Clinical Endoscopy. 49 (2): 147–56. doi:10.5946/ce.2015.044. PMC 48215224821522. PMID 26878326.
  • ^ Hopkins, J; Switzer, NJ; Karmali, S (25 August 2015). "". World Journal of Gastrointestinal Endoscopy. 7 (11): 1039–44. doi:10.4253/wjge.v7.i11.1039. PMC 45496614549661. PMID 26322157.
  • Drip gerd nasal post Foods To Eat And Avoid (⭐️ Heartburn Remedies) | Drip gerd nasal post Best Drinks Forhow to Drip gerd nasal post for ^ Mahadevan U, Kane S (July 2006). "". Gastroenterology. 131 (1): 278–82. doi:10.1053/j.gastro.2006.04.048. PMID 16831610.Mahadevan U, Kane S (July 2006). "". Gastroenterology. 131 (1): 278–82. doi:10.1053/j.gastro.2006.04.048. PMID 16831610.
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  • Drip gerd nasal post What To Eat (🔴 Diet For) | Drip gerd nasal post 7 Foods That Causehow to Drip gerd nasal post for ^ van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA (May 2011). "". Pediatrics. 127 (5): 925–35. doi:10.1542/peds.2010-2719. PMID 21464183.
  • ^ Fedorak RN, Veldhuyzen van Zanten S, Bridges R (July 2010). "". Canadian Journal of Gastroenterology. 24 (7): 431–4. doi:10.1155/2010/296584. PMC 2918483. PMID 20652158. Lay summary.
  • ^^ Jafri SM, Arora G, Triadafilopoulos G (July 2009). "". Current Opinion in Gastroenterology. 25 (4): 352–7. doi:10.1097/MOG.0b013e32832ad8b4. PMID 19342950.Jafri SM, Arora G, Triadafilopoulos G (July 2009). "". Current Opinion in Gastroenterology. 25 (4): 352–7. doi:10.1097/MOG.0b013e32832ad8b4. PMID 19342950.
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  • External links[edit]

    Classification
    External resources
    Diseases of the digestive system (primarily K20–K93, 530–579)
    Upper GI tract
    Esophagus
    Stomach
    Lower GI tract:
    Intestinal/
    Enteropathy
    Small intestine
    (Duodenum/Jejunum/Ileum)
    Large intestine
    (Appendix/Colon)
    Large and/or small
    Gallbladder
    Bile duct/
    Other biliary tree

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