Gastroesophageal Reflux Disease (GERD)
Which are the symptoms?
Gastro-oesophageal reflux disease may manifest with what are called "typical" symptoms, such as a retrosternal burning, which usually increases at night when lying down, and regurgitation of acidic material into the mouth. Even sometimes the retrosternal pain is so intense that it is difficult to distinguish it from cardiac pain. In addition, the disease may present with symptoms called "atypical" or "extra-esophageal," the cause of which is nevertheless related to increased acid levels in the esophagus; these include unseasonal bronchial asthma, chronic hoarseness, low voice, cough, chronic laryngitis, dental erosion, and difficulty or painful swallowing. There is also a suspected association with the occurrence of sinusitis, pharyngitis, and recurrent otitis media.
How is it diagnosed?
The main examinations allowing a correct diagnosis are a trial treatment with antisecretory drugs for at least 8 weeks, esophagogastroduodenoscopy, which documents the presence or absence of esophagitis (inflammation of the esophagus with erosions of the esophageal mucosa, which can have different degrees of severity, from A to D) and its complications (ulcers stenosis, Barrett's esophagus, which requires specialized treatment and monitoring to avoid the possible development of cancer), esophageal manometry, which studies the motor activity of the esophagus and lower esophageal sphincter, and 24-hour pH-impedanceometry, which documents the actual impact of an acidic, mildly acidic or non-acidic environment on the esophagus. Another test that may be performed is an esophageal barium test, in which the patient is given a small amount of whitish contrast agent to drink, which allows visualization of the anatomy and function of the esophagus, stomach, and first small intestine.
How is it treated?
Dietary and behavioral measures are important: reducing body weight (especially the abdominal circumference), frequent and small meals, avoiding excess fatty or fried food, chocolate, mint, tomatoes, citrus fruits, alcohol, smoking, caffeine, some medications (nitrates, calcium channel blockers); raising the headboard with elevators (do not increase the number of pillows, this can be counterproductive); avoiding too tight clothing; avoiding full stomach exertion; avoiding lying down after eating. The next step includes medications of different classes: antacids, antireflux medications, prokinetics, gastric acid secretion inhibitors (anti-H2 and proton pump inhibitors). Antireflux surgery is a treatment option that may be considered for selected patients, especially those whose esophagus is refractory to treatment, has persistent symptoms, or has an intolerance to antisecretory drugs.