Gastroesophageal reflux disease (GERD) is one of the most common chronic diseases - it is diagnosed in 20 percent. population. It is based on incorrect reflux into the esophagus. GERD is a multifactorial disease that occurs with periods of exacerbation and remission. Untreated, severe gastroesophageal reflux disease can lead to serious complications (such as ulcers, narrowing, Barrett's esophagus, adenocarcinoma).
The pathomechanism of gastroesophageal reflux disease involves the anti-reflux barrier, in which the lower esophageal sphincter (LES) plays a key role. This is a 2-5 cm esophagus segment within which there is a zone of increased resting pressure. LES prevents reflux into the esophagus.
The lower esophageal sphincter is involved in the last phase of food transport from the mouth through the esophagus to the stomach. As a result of peristaltic contractions of the esophagus and the action of the vagus nerve, LES loosens. After approx. 2 seconds the sphincter relaxes after swallowing, which lasts for 4-6 seconds. After the peristaltic wave passes through the esophagus, there is a post-relaxation LES contraction, return to baseline pressure and anti-reflux barrier.
Under normal conditions, the voltage within the LES is sufficient to prevent swallowing substances from entering the esophagus.
Gastroesophageal reflux disease develops when the pressure within the LES is too low (does not prevent regurgitation of gastric contents) or when the sphincter undergoes spontaneous relaxation that is not associated with a normal esophageal peristaltic wave. These mechanisms can lead to pathological reflux episodes.
In GERD, damaging factors (e.g. hydrochloric acid) break down defense mechanisms (anti-reflux barrier), causing damage to the esophageal mucosa.
Gastroesophageal reflux disease can be asymptomatic (GERD is diagnosed accidentally, e.g. by endoscopy).
Esophageal (typical) symptoms include:
Esophageal symptoms increase when you bend, lie down on your back or pressure (especially after heavy / greasy meals).
Esophageal symptoms may be accompanied by extrasophageal symptoms.
Extra-esophageal symptoms (atypical) include:
Exesophageal symptoms can occur without esophageal (typical) symptoms.
Alarm symptoms are an indication for urgent endoscopic diagnosis. This group includes:
Gastroesophageal reflux disease is most often diagnosed based on medical history and physical examination. In typical cases, ancillary tests are usually not necessary.
However, the esophageal pH meter is considered the gold standard for GERD recognition, i.e. 24-hour outpatient esophageal pH testing with impedance measurement. The method involves placing the probe in the esophagus (inserted through the nose) daily. The probe (with a special electrode) measures the concentration of hydrogen ions.
Esophageal impedance testing is based on the measurement of electrical conductivity in the esophagus. The methods enable, among others Detection of reflux and determination of its nature (acid / non-acid).
In some cases, there may be indications for other additional tests, e.g. endoscopy with esophageal biopsy, esophageal manometry, and x-ray contrast.
Gastroesophageal reflux disease is a chronic disease that requires constant therapy and lifestyle modification.
The basis of the pharmacological treatment of GERD are drugs that inhibit the secretion of hydrochloric acid (primarily proton pump inhibitors). The therapy may be supplemented with prokinetic drugs (improving the functioning of the anti-reflux barrier).
In mild conditions (e.g. sporadic heartburn), only antacid and mucosal screening agents (e.g. magnesium and aluminum compounds, alginic acid, sucralfate) are usually recommended - they can be used on an ad hoc basis.
Antacida (antacid) drugs have been used for decades - they provide quick relief from dyspeptic problems. There are many forms and types of these drugs - today they are most often used as components of combined preparations. Sodium bicarbonate (earliest used) reacts quickly with hydrochloric acid, releasing CO2 (carbon dioxide) and NaCl (sodium chloride). Calcium carbonate is less soluble; reacts slightly more slowly with hydrochloric acid and turns into CaCl2 (calcium chloride).
Herbal preparations that have a protective effect on the gastrointestinal tract, e.g. wild mallow (Malva sylvestris L.) - a medicinal plant of the family Maltaceae (Malvaceae) can also provide relief from mild ailments. Its flowers and leaves contain significant amounts of mucus, which coat the mucous membranes, preventing them from irritation; also has anti-inflammatory properties.
In some cases, surgical treatment for GERD is considered.