September 28, 2022 Author : Juliana Oliveira Gastroesophageal reflux is the movement of stomach contents into the esophagus without being caused by vomiting. It occurs sporadically at any age, without symptoms, or occasionally with a transient feeling of heartburn. When it occurs repeatedly it can give rise to symptoms and is then referred to as gastroesophageal reflux disease (GERD) . Gastroesophageal reflux disease affects about 10%-20% adult population. What causes gastroesophageal reflux disease In most cases, gastroesophageal reflux disease is due to changes in the anatomy or functioning of the lower esophageal sphincter . The esophagus belongs to the digestive system, has a tube shape, and crosses the diaphragm connecting the pharynx to the stomach. At the transition from the esophagus to the stomach there is a muscular ring – the lower esophageal sphincter – that controls the passage of food and liquids between the esophagus and the stomach . This sphincter allows the passage of food content into the stomach, closing it afterwards, preventing its return. When the lower esophageal sphincter does not close properly, the stomach contents, which are acidic, flow back into the esophagus. The frequent passage of acidic contents into the esophagus can cause inflammation of the esophageal wall (esophagitis) which, if persisting, can progress to pre-malignant lesions (Barrett esophagus). Risk factors The most common risk factors for gastroesophageal reflux disease are: Obesity; Smoking; Consumption of alcohol and coffee; Esophageal hiatus hernias, in which part of the stomach slides into the thorax, through the diaphragmatic orifice. There are also some diseases that predispose to gastro-esophageal reflux disease. In pregnant women, gastroesophageal reflux is usually transient and is due to increased intra-abdominal volume. Symptoms and diagnosis of gastroesophageal reflux disease The most common symptoms (50%-70% cases) are: Heartburn, which is a burning sensation in the chest that can reach the throat; Backflow of acidic/food contents into mouth and throat. Other possible but less frequent symptoms are: Chest pain; Abdominal pain; Difficulty or pain in swallowing (dysphagia); Sore throat (odynophagia), hoarseness or cough; Nausea and vomiting; Respiratory infections; Dental problems. The diagnosis of gastroesophageal reflux disease is made based on: Clinical history and patient complaints; Physical exam; Results of additional diagnostic tests that the doctor deems necessary. The most common are: Upper digestive endoscopy; Esophageal manometry and pHmetry, which assess acid reflux and esophageal motility; Esophagogastric transit; Thoracoabdominal computed tomography. Treatment of gastroesophageal reflux disease The treatment of gastroesophageal reflux disease is indicated to improve symptoms and to avoid possible complications of the disease , such as esophagitis, esophageal stricture and Barrett esophagus. This treatment is individually planned and may include: Lifestyle modifications Weight loss (with exercise and diet); Quit smoking; Avoid heavy meals and fluids close to bedtime; Sleep with the head of the bed higher; Avoid chocolate, high fat foods, alcohol, coffee, carbonated drinks and acidic foods. Drug therapy Medication for the treatment of gastroesophageal reflux disease is usually based on inhibitors of acid production by the stomach and on drugs that improve esophagogastric emptying, being adapted on a case-by-case basis. Surgery Surgery may be an option when other treatments are not as successful and/or when a complication or hiatal hernia is present. The aim of surgery is to strengthen the lower esophageal sphincter and correct a hiatal hernia when it is present. The most frequently performed technique is called Nissen fundoplication and is performed by minimally invasive surgery (laparoscopy) by physicians specializing in general surgery. Meet the general surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
