Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease (GERD) And Esophagitis​ is the medical term for a condition in which the contents of the stomach or duodenum flow into the esophagus. It may occur normally or as a persistent pathological disease.

Gastroesophageal Reflux Disease Definition

Gastro-esophageal reflux disease (GERD)

GERD is the medical term for a condition in which the contents of the stomach or duodenum flow into the esophagus. It may occur normally or as a persistent pathological disease.

Heartburn

Acid reflux from the stomach into the esophagus causes a painful burning sensation behind the breastbone, known as heartburn.

Esophagitis

When the esophagus becomes inflamed, it is referred to as esophagitis.Approximately 5–10% of women in wealthy nations suffer with PCOS. An estimated 3% to 12% of women in Western nations have polycystic ovarian syndrome (PCOS), a prevalent endocrine condition with no known etiology.

 

Prevalence

Four in ten Americans have Gastroesophageal Reflux Disease GERD symptoms monthly; seventeen percent experience them weekly; and seven percent experience them daily in the United States. About 16% of the adult Asian population suffers from Reflux esophagitis (RE).

Symptoms

Gastroesophageal Reflux Disease (GERD)

  • Acid reflux caused by stomach acid
  • Sub-sternal pain associated with heartburn
  • Esophageal spasm causing belching

In children

  • Vomiting
  • Dysphagia
  • Refusal to eat
  • Complaints of abdominal pain

Esophagitis

Esophagitis might develop after years of dealing with an erosive condition.

  • Sleep disruption is a common symptom
  • Dysphagia
  • Stricture formation
  • Ulceration

Clinical Presentation Typical/ Esophageal

Typical/ Esophageal

  • Heartburn
  • Acid regurgitation

A typical/Supra-esophageal

  • Chest pain
  • Laryngitis
  • Asthma
  • Sinusitis
  • Chronic cough
  • Aspiration pneumonia
  • Tooth decay
GASTRO-ESOPHAGEAL REFLUX DISEASE

Risk Factors

  • Ingestion of a corrosive agent
  • Viral infection
  • Risk of reflux
  • Hiatal hernia
  • Reduced lower esophageal sphincter pressure
  • Tobacco use
  • Increased abdominal pressure
  • Delayed gastric emptying
  • Recurrent vomiting
  • Pregnancy

Complications

  • Eosinophilic Esophagitis
  • Erosive Esophagitis
  • Stricture Esophagitis
  • Barrett’s Esophagus

Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis (EoE) is a persistent immune-mediated illness characterized by esophageal dysfunction and eosinophil infiltration into the esophageal mucosa.

Erosive Esophagitis

40-60% of acid reflux symptoms are due to the erosive esophagitis. Symptoms of erosive esophagitis are not always proportional to the disease’s severity.

Esophageal stricture

It occurs as a result of healing of erosive esophagitis and may need dilation.

Gastroesophageal Reflux Disease Esophageal stricture

Erosive Esophagitis

In Barrett’s Esophagitis columnar metaplasia of the esophagus occurs which is associated with the development of adenocarcinoma.

Medical Nutrition Therapy

Six-food Group Elimination Diet (SFGED) containing foods which are associated most common food allergies and esophageal eosinophilia

  • Cow’s milk protein
  • Soy
  • Wheat
  • Eggs
  • Peanuts/tree nuts
  • Fish/ shellfish

Adults also showed improvement up to 50%.

Life-style Modifications:

  • Avoid eating within 3 hours after meal
  • Avoid lying down after meals
  • Avoid wearing tight-fitting garments
  • Avoid Cigarette smoking

Nutritional Recommendations:

    • Additional calories, protein, and/or micronutrients may be required
    • Nutritional supplements should be recommended
    • Carbohydrate intake should provide 45% to 55% of total calories such as whole grains, fruits, and vegetables for nutrients and fiber
    • Wheat often is removed from the diet of children who have erosive esophagitis, necessitating the use of alternate grain sources
    • About 20-25% Fats are usually recommended

References

    1. S. Sandler, J. E. Everhart, M. Donowitz et al., “The burden of selected digestive diseases in the United States,” Journal of Gastroenterology, vol. 122, no. 5, pp. 1500–1511, 2002.
    2. Wu, S. C. Xu, Y. Chen, F. F. Zheng, C. Wang, and L. W. Yao, “Evaluation of symptoms  and quality of life of None-erosive reflux disease patients,” Chinese Journal of Digestive,  vol. 28, pp. 706–709, 2008.
    3. Fass, “Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics,” Journal of Clinical Gastroenterology, vol. 41, no. 2, pp. 131–137, 2007.
    4. O Moawad F, Veerappan G, Lake J, et al. Correlation between eosinophilic oesophagitis and aeroallergens. Aliment Pharmacol Ther 2010;31:509–515.
    5. Hurrell JM, Genta RM, Dellon ES. Prevalence of esophageal eosinophilia varies by climate zone in the United States.  Am J Gastroenterol 2012;107:698–706.
    6. Dent, H. B. El-Serag, M. A. Wallander, and S. Johansson, “Epidemiology of gastro-oesophageal reflux disease: a systematic review,” Gut, vol. 54, no. 5, pp. 710–717, 2005.
    7. J. Song, K. N. Shim, S. J. Yoon et al., “The Prevalence and clinical characteristics of reflux esophagitis in Koreans  and its possible relation to metabolic syndrome,” Journal of Korean Medical Science, vol. 24, no. 2, pp. 197–202, 2009.
    8. Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and  consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342–1363.
    9. Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3–20.
    10. Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 2013;108:679–692, quiz  693.
    11. Mishra A, Hogan SP, Brandt EB, et al. An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001;107:83–90.
    12. Spergel JM. Eosinophilic esophagitis in adults and children: evidence for a food allergy component in many patients. Curr Opin Allergy Clin Immunology 2007;7:274–278.
    13. Spergel JM, Brown-Whitehorn TF, Beausoleil JL, et al. 14 Years of eosinophilic esophagitis: clinical features and prognosis. J Pediatr Gastroenterol Nutr 2009;48:30–36.
    14. Kagalwalla AF, Shah A, Li BUK, et al. Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet. J Pediatr Gastroenterol Nutr 2011;53:145.
    15. Kagalwalla AF, Sentongo TA, Ritz S, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006;4:  1097–1102.
    16. Caldwell JM, Blanchard C, Collins MH, et al. Glucocorticoidregulated genes in eosinophilic esophagitis: a role for FKBP51. J Allergy Clin Immunol 2010;125:879–888.e8.
    17. Molina-Infante J, Martin-Noguerol E, Alvarado-Arenas M, et al. Selective elimination diet based on skin testing has suboptimal efficacy for adult eosinophilic  esophagitis. J Allergy Clin Immunol 2012;130:1200–1202.
    18. Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al.  Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic  esophagitis. Clin Gastroenterol Hepatol 2006;4:1097-102.
    19. Molina-Infante J, Arias A, Barrio J, Rodríguez-Sánchez J, Sanchez-Cazalilla M,  Lucendo AJ. Four-food group elimination diet for adult eosinophilic esophagitis: a prospective multicenter study. Journal of Allergy and Clinical Immunology. 2014 Nov 1;134(5):1093-9.
    20. Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med.  2006;166:965-971.
    21. Wolf WA, Jerath MR, Sperry SL, Shaheen NJ, Dellon ES. Dietary elimination therapy is an effective option for adults with eosinophilic esophagitis. Clinical Gastroenterology and Hepatology. 2014 Aug 1;12(8):1272-9.