No "burn" and no "reflux" and no worries - pay attention to those things about gastroesophageal reflux disease

Author: Shen Yuanyuan, deputy chief physician of Yantai Affiliated Hospital of Binzhou Medical College

Reviewer: Cao Xiaoling, Chief Physician, Director of Digestive Endoscopy Department, Yantai Affiliated Hospital of Binzhou Medical College

Friends, do you often feel a warm current flowing into your throat? This is not a happy heartbeat experience, but it may be a disease called "gastroesophageal reflux". Now, let's learn about this disease together.

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1. What is gastroesophageal reflux disease?

Gastroesophageal reflux disease (GERD)[1] is a chronic disease caused by the reflux of gastric and duodenal contents into the esophagus or oral cavity, which causes discomfort symptoms and/or complications. It is divided into non-erosive reflux disease (NERD), reflux esophagitis (RE) and Barrett's esophagus (BE) based on endoscopic manifestations.

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2. What are the symptoms of gastroesophageal reflux disease? [1-2]

Typical symptoms include regurgitation (the backflow of gastric contents into the pharynx or mouth) and heartburn (a burning sensation behind the breastbone that may extend up into the throat).

Atypical symptoms: may present as chest pain, upper abdominal pain and belching.

Extraesophageal symptoms: may manifest as throat discomfort, chronic cough, asthma and dental erosion.

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3. Why do these symptoms occur?

These symptoms are mainly caused by the following factors: first, abnormal structure (such as hiatal hernia) and function (such as increased intragastric pressure caused by a high-fat diet) of the anti-reflux barrier; second, reduced esophageal clearance (such as reduced saliva secretion caused by Sjögren's syndrome, which affects the cleaning ability of the esophagus); and finally, reduced esophageal mucosal barrier function (such as damage to the esophageal mucosa caused by long-term smoking and drinking). In layman's terms, it means "cannot be turned off" (weakened anti-reflux barrier function), "cannot be removed" (decreased esophageal clearance ability), and "cannot be protected" (damaged esophageal mucosal barrier).

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4. How to diagnose gastroesophageal reflux disease?

If you often feel a warm current rushing into your throat, it is recommended to go to the hospital for a gastroscopy. If erosion of the esophagus is observed under gastroscopy, it can be diagnosed as reflux esophagitis (RE), and it is divided into four levels ABCD according to the Los Angeles grading standard (from mild to severe). However, if the esophageal mucosa appears normal under gastroscopy, you need to undergo further examinations, such as 24-hour esophageal pH monitoring and esophageal manometry. If these follow-up tests are positive, non-erosive reflux disease (NERD) can be diagnosed.

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5. How to treat gastroesophageal reflux disease?

Basic treatment: Adjusting your lifestyle is of utmost importance. Please remember the following tips.

Exercise more, control your weight, and avoid growing a big belly!

Quit smoking and drinking, eat less sweets, and say goodbye to coffee and strong tea!

To prevent constipation, lift the head of the bed and move around after meals before lying down!

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Drug treatment: mainly acid suppressants, such as proton pump inhibitors or potassium ion competitive acid blockers, are used, and the course of treatment is usually 8 weeks. In addition, auxiliary treatments such as gastrointestinal motility drugs and antacids are also included.

If drug treatment is ineffective, endoscopic treatment, such as endoscopic radiofrequency ablation, antireflux mucosal resection, and peroral endoscopic cardia stenosis, can be considered. For patients with hiatal hernia, surgical procedures such as fundoplication are also a viable option.

Through the above introduction, I believe everyone has a certain understanding of gastroesophageal reflux disease. I hope we can establish a good lifestyle, adopt standardized and reasonable treatment methods, and truly achieve a healthy life without "heartburn" (heartburn) and "reflux" (flow)!

References:

[1] Gastrointestinal Motility Group, Gastrointestinal Functional Diseases Collaborative Group, Esophageal Diseases Collaborative Group, Chinese Society of Gastroenterology. Chinese Guidelines for Diagnosis and Treatment of Gastroesophageal Reflux Disease[J]. Chinese Journal of Gastroenterology, 2023, 43(9): 588-598.

[2] Ge Junbo, Xu Yongjian, Wang Chen. Internal Medicine[M]. 9th edition. Beijing: People's Medical Publishing House, 2018: 347-349.