Gastroesophageal reflux is a disorder characterized by the involuntary ascent of the acid content of the stomach, upwards, therefore into the esophagus. Within certain limits it is a physiological phenomenon, therefore normal; however, when it becomes too intense and frequent it causes a whole series of ailments to the patient, thus trespassing into the pathological. In these cases we speak more correctly of gastroesophageal reflux disease. When we eat, the ingested food passes from the esophagus to the stomach, and then continues the cycle of digestion. Between the esophagus and the stomach exists a kind of valve that regulates the passage of food, called the gastroesophageal sphincter and belonging to the cardia. This valve opens to allow food to pass after swallowing and closes immediately afterwards; in this way, it prevents the acidic contents of the stomach from going back up into the esophagus and damaging it with its acidity. In people with GERD this valve does not work well, that is, it opens when it shouldn't. Consequently, food and juices stomach can flow back towards the esophagus causing an unpleasant burning sensation in the pit of the stomach, acid regurgitation, bad breath or excessive salivation.These acid "humors" can even reach the throat, causing symptoms such as cough and burning in this area as well. Gastroesophageal reflux can be a transient disorder, but it can also become a real disease subject to serious complications. In the milder forms, it is possible to intervene successfully by simply changing diet and lifestyle. In more serious cases, however, these rules must be complemented by a specific drug treatment.
The causes of gastroesophageal reflux can be different. We have already said that at the root of the problem we find the incontinence of the valve that separates the stomach from the esophagus, which, by not closing properly, lets the gastric contents rise. The reasons why the valve does not close as it should are numerous. Among the major ones we remember the intake of certain drugs, the irritable bowel syndrome or the presence of a hiatal hernia. Pregnancy, obesity, stress, cigarette smoking and prolonged stay of food in the stomach can also favor the appearance of symptoms. Other possible causes can be attributed to incorrect eating habits and unhealthy lifestyles, such as going to bed immediately after meals or the habit of eating quickly and chewing little. As we have already pointed out, gastroesophageal reflux tends to occur occasionally in all people, especially in infants and the elderly, and we usually don't even realize it. Other times, however, reflux becomes so frequent and annoying that it becomes a real pathology, so much so that we talk about gastroesophageal reflux disease. In this case, it is best to immediately contact a doctor who can advise on what to do. Unfortunately, precisely because acidity disorders are very common among the population, the patient often turns to the doctor only after years of living with the disease. This is obviously a wrong behavior, since underestimating the alarm bells can cause serious complications.
The characteristic symptoms of gastroesophageal reflux are heartburn and regurgitation. Heartburn is nothing more than an annoying burning sensation at the retrosternal level, while regurgitation is the return to the throat or mouth of the acidic material contained in the stomach. Chest pain and excessive salivation are also very common. In addition to these frequent symptoms, other less common symptoms may also be present, called atypical, which include difficulty swallowing, nausea, vomiting, gastric swelling, hiccups, respiratory disorders with chronic cough, hoarseness, laryngitis and even asthma. Symptoms can occur continuously throughout the day or intermittently. For example, reflux can occur upon waking, after meals and during the night, or occur only in a lying position and while bending forward, for example, while it is obvious that these symptoms, in addition to compromising health, greatly affect the quality of life, also negatively affecting the night's rest.
As for the complications we have mentioned several times, if it is not properly treated, gastroesophageal reflux disease can damage the mucous membrane of the esophagus causing esophagitis, ulceration, bleeding and stricture; moreover, the repeated acid insults can cause cellular alterations of the "esophagus giving rise to precancerous lesions, including Barrett's esophagus.
Although frequent stinging behind the chest and acid regurgitation clearly indicate the presence of reflux, tests still need to be done to confirm the diagnosis. In this regard, several instrumental options are available; let's see the main ones together. Among the tests that contribute to the certain diagnosis of reflux disease, we mention for example the measurement of esophageal pH. The method involves the introduction of a thin tube which, passing through the nose, is brought up to the level of the "esophagus-stomach passage." The probe is then connected to a "recorder" capable of analyzing the variations in acidity during a period of 24 hours, both at the esophageal and pharyngolaryngeal level. The pH-metry therefore allows to measure the number of reflux episodes, the quantity of refluxed material, any correlation with the patient's position and with food intake. However, the most common and known examination remains the esophagus-gastric endoscopy, more simply called gastroscopy, based on the use of a flexible instrument, introduced from the mouth. The examination makes it possible to diagnose "esophagitis due to pathological reflux. In other words, the investigation informs about the presence of inflammation of the esophageal mucosa and the possible existence of other concomitant pathologies, such as hiatal hernia, gastritis, ulcer and neoplasms. In addition to allowing the visual examination of these organs, in fact, gastroscopy also allows the removal of small fragments of mucosa to be subjected to histological examination. Another available investigation is gastroesophageal manometry, useful for evaluating if there are abnormalities in the motility of the esophagus. and continence of the cardia. The radiological examination of the upper digestive tract, on the other hand, is especially indicated when an anatomical malformation is suspected, as in the case, for example, of a narrowing of the esophageal lumen, a hiatal hernia or other obstructive lesions.
The medical treatment of gastroesophageal reflux mainly uses drugs capable of breaking down gastric acid secretion. In this regard, the use of proton pump inhibitors, such as omeprazole or pantoprazole, or histamine H2 receptor antagonists, such as famotidine and ranitidine, is envisaged. Other particularly useful drugs are the so-called prokinetics, the which act by accelerating gastric emptying, thus preventing reflux and stimulating the motility of the digestive system. A minor role than in the past have antacids, which neutralize the acid in the stomach, without however guaranteeing a significant therapeutic result. These drugs can however be combined with other therapies, as a symptomatic remedy. Finally, in fortunately rare cases, a surgery to prevent reflux itself This “extreme” measure is reserved for patients who are unresponsive to medications and who have concurrent anatomical problems, such as severe hiatus hernias.
Before thinking about drugs, and in any case in association with them, it is essential to implement specific dietary and behavioral measures that can alleviate the symptoms of gastroesophageal reflux. As for nutrition, meals should be easy to digest and not too copious. Foods rich in fats, such as many sausages, and fried foods, which delay gastric emptying, should therefore be minimized. In addition, certain foods that could worsen acidity, such as chocolate, coffee, alcohol, mint, spicy condiments and those based on vinegar and lemon should be absolutely avoided. It is also necessary to limit the intake of citrus fruits and tomatoes, as well as their juices. A valuable piece of advice is clearly to eat slowly, chewing each bite well, possibly in a relaxing environment. It is also advisable to avoid assuming the horizontal position immediately after eating. Before lying down, it would be advisable to wait at least 2-3 hours. In addition to all this, if an overweight condition is present, it is important to gradually reduce weight and abdominal circumference through a slightly low-calorie diet associated with regular motor activity. Another useful preventive measure is certainly to quit smoking; smoking, in fact, favors the relaxation of the esophageal sphincter, favoring reflux. To improve the symptoms of gastroesophageal reflux and the quality of sleep, it is also possible to raise the headboard of the bed by about 15 cm, so as to sleep with the head and torso slightly raised; instead, piles of pillows that are too high should be avoided as they would increase intra-abdominal pressure. As a final piece of advice, it is important to avoid wearing belts or clothing that are too tight at the waist, as they tend to increase abdominal pressure.
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