Gastroesophageal Reflux Disea... Health Article

Definition

Gastroesophageal reflux disease (GERD) is a gastric disorder which causes stomach acids to back up into the esophagus, the tube leading from the mouth to the stomach. This action causes pain, which is often called heartburn. GERD can disrupt sleep and make eating difficult. It can lead to respiratory infections, ulcers, and even cancer.

Description

The reflux action of gastroesophageal reflux disease is a function of the weakening of the lower esophageal sphincter (LES). The LES is a muscle located at the bottom of the esophagus and acts as a doorkeeper to the stomach. When food is eaten, it passes through the esophagus and the LES and into the stomach. The LES closes after food enters the stomach and usually keeps the stomach contents from returning up the esophagus.

In an infant, the LES may not be well formed, which causes the baby to spit up or vomit. In an older child or adolescent, the LES weakens and acids from the stomach come into the esophagus, causing the characteristic burning in the middle of the chest, known as heartburn.

Everyone has experienced this reflux occasionally, and it is not a concern. It is when the reflux occurs often that the condition should be evaluated. Infants and children who do not vomit or complain of heart-burn or stomachache may have this condition. When the stomach contents moves into the esophagus, there is the possibility that this material will be aspirated into the windpipe, which can cause asthma, pneumonia, and possibly suffocation or sudden death. GERD was thought to be implicated in sudden infant death syndrome (SIDS); however, subsequent studies concluded it was not.

Some children and adults have few episodes of heart-burn over their lifetimes, but they have frequent bouts of ear infection, sinusitis, bronchitis, and even asthma. Some children and adults only experience a vague indigestion. They come to the doctor because they are having trouble eating. They feel that there is something in their throats or that their food keeps getting stuck when they eat. This may be a serious condition called dysphagia, which develops from long-term GERD. The stricture of the esophagus is caused by a thickening of the lining of the esophagus in response to acids from the stomach. Sometimes, when swallowing hurts, the condition is called odynophagia. This type of GERD is often referred to as silent reflux.

Constant irritation by stomach acids in the esophagus can cause a condition called esophagitis, in which the esophagus becomes red and irritated. Because the lining of the esophagus is thinner and not as acid-proof as the stomach or the intestines, undiagnosed GERD over many years can cause ulcers along the esophagus. These can bleed and can, in turn, result in anemia. Scar tissue can also build up.

Sometimes, the body tries to protect the esophagus by growing a thicker lining, made up of cells like those in the stomach and intestine. This is known as Barrett's esophagus and is a pre-cancerous condition that usually leads to cancer of the esophagus.

Demographics

One-third of the adult population (95 million) have GERD symptoms once a month, while 15 million have symptoms every day. Though half of people who have GERD are between the ages of 45 and 64, infants, children, and teenagers also have GERD.

GERD affects 50 percent of all healthy, full-term newborns. It is the primary reason for most vomiting in infants during the first four months, at which time the vomiting should stop. Less than 5 percent of infants with GERD continue the problem into adulthood. However, this figure may be revised upward as more and more young children experience GERD symptoms and are diagnosed with this condition.

Some children seem to be more at risk for having GERD than others, particularly children who have hiatal hernia, cystic fibrosis, neurological impairment or delay, or an immature esophagus and LES.