A report released in November by the Asia-Pacific Consensus on the Management of Gastroesophageal Reflux Disease (APCMGERD) said the prevalence of GERD among Filipinos has significantly increased over the last decade. It cited a study by the endoscopy unit of the University of Santo Tomas Hospital titled "Erosive esophagitis in the Philippines: A comparison between two time periods," which said the "prevalence of GERD was significantly higher in 2000-2003 than in 1994-1997." Published in the Journal of Gastroenterology and Hepatology, it also noted that in Asia the incidence of GERD diagnosed through endoscopy has increased from three to nine percent to 14 to 16 percent in the same period.

    When a person is not eating, the LES squeezes shut to close the stomach off from the esophagus. When a person eats, the LES relaxes, opening up to let swallowed food through to the stomach. In GERD patients, the LES opens more often than it should, causing stomach acids to go the wrong way.

    If this situation continues over an extended period, the esophagus literally gets corroded raw and will lead to a condition called erosive esophagitis, which can lead to scarring, ulcers, and bleeding in the esophagus. Chronic GERD can also lead to a condition called Barrett's esophagus, which increases a person's risk of developing cancer of the esophagus.

    While the reasons for GERD are still unclear, anatomical abnormalities, such as hiatal hernia may contribute to its occurrence. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the wall of muscle separating the stomach from the chest. When such an hernia is present, acid reflux occurs more easily, and this hernia can occur in people of any age, though it is most often found in people over 50. Most of the time a hiatal hernia has no symptoms.

    Common acid-reflux triggers include chocolate, peppermint, alcoholic drinks, beverages with caffeine, citrus fruits and drinks, spicy food, tomato-based foods, fatty or fried foods, as well as garlic and onions. Smoking, being overweight or obese, overeating, bending over after eating, and lying down within three hours of having a meal may also trigger acid reflux. Pregnancy can also sometimes trigger GERD.

    Most medical treatments for GERD focus on decreasing the acidity of the stomach's contents, but lifestyle changes to reduce acid secretions are also recommended by gastric specialists as corollary measures to medication and other therapies.

    The most common symptom of GERD is heartburn, which is defined as "a burning pain that rises from the stomach or lower part of the chest toward the neck." Other symptoms are regurgitation (often by vomiting)-which occurs when stomach acid rises up the esophagus and into the mouth, causing a bitter or sour taste-and difficulty or pain when swallowing (dysphagia).

    The more obscure symptoms include "water brash," or the sudden appearance in the mouth of slightly sour or salty fluid when the salivary glands are stimulated by acid reflux. GERD is also associated with "noncardiac chest pain," asthma, hoarseness, and a chronic cough.

    There is also asymptomatic GERD, where patients do not experience any symptoms because they are not very sensitive to the acid and do not experience pain even though they are having acid reflux episodes. M

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Diagnosing GERD

 

The first step in diagnosis is consultation, with the doctor asking the patient to describe any symptoms he may be experiencing, as well as their severity and frequency of occurrence. The doctor will also want to know if the patient is taking or has taken any over-the-counter medications or herbal preparations and whether these remedies provided any relief.

    Depending on the severity of symptoms, the doctor may recommend lifestyle modifications as trial treatment along with the appropriate medicines. If the medication works, an initial diagnosis of GERD may be made and no additional tests may be required if the treatment is effective.

    If the initial course of treatment does not provide relief, or if the patient shows "alarm symptoms" such as weight loss, anemia, bleeding in the gastrointestinal tract as shown by bloody vomit or bloody stools or dysphagia, the doctor may order further tests.

    These tests will depend on the type and severity of symptoms and may include endoscopy, a barium esophagram of the upper gastrointestinal tract, and an esophageal pH monitoring.

    Endoscopy uses a thin, bendable tube with a video camera to see if the esophagus has been damaged. The tube or endoscope is put into the mouth and passed down the esophagus into the stomach to identify injured areas of the esophagus. Patients are usually sedated during this procedure.

    The barium esophagram looks for changes in the shape of the esophagus and is used to detect abnormalities in the esophageal lining, as well as reflux of the barium during the test. The shape of the stomach can also be seen using this test. The patient drinks a chalky liquid that contains barium, which coats the esophagus and stomach so the doctor can see the outline of the esophagus and stomach on an X-ray.

    Esophageal pH monitoring is used to measure the severity of the acid reflux by measuring the amount of acid in the esophagus over time and determining how long acid stays in the esophagus.

    This test can be conducted in two ways: In the first manner, a tiny tube with an acid monitor attached to it is inserted through the nose and down the esophagus to measure acid levels for 24 hours. The second manner requires the use of an endoscope to attach a monitor the size of a medicine capsule to the esophagus. The monitor stays in the esophagus and tests for acid over time. After about 48 hours, the monitor is passed out of the body along with the patient's normal bowel movement. M Alma Anonas-Carpio

 

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