Gastroesophageal reflux is a normal physiological phenomenon with no consequent symptoms. It is short-lived and intermittent, particularly after meals.
When there are symptoms and these reoccur, the problem becomes chronic and is referred to as “heartburn” or gastroesophageal reflux disease. This occurs when the stomach contents flow up into the oesophagus. It is considered the most common chronic illness of the upper digestive system.
Gastroesophageal reflux occurs due to the combination of two factors:
■ External factors or aggression of the oesophageal mucosa, mainly caused by various types of food (tomato and its derivatives, citrus juices, chocolate, beverages containing caffeine), tobacco, alcohol and some medication (estrogens, oral contraceptives).
■ Internal factors due to structural alteration, and include the hiatus hernia (when a portion of the stomach contents passes through the diaphragm into the thoracic cavity) and/or a dysfunction of the lower oesophageal sphincter.
It is common to observe an association between these two factors. In fact, the most important mechanism of gastroesophageal reflux is the temporary relaxation of the lower oesophageal sphincter, which lasts from five to 35 seconds. It is not related to swallowing and occurs when there is gastric distension due to food or gas.
There are also other situations that increase gastroesophageal reflux: increased intra-abdominal pressure (tight clothing, pregnancy, coughing, obesity, sudden physical exercise that increases intra-abdominal pressure, constipation).
The signs and symptoms are varied, however, the most typical are heartburn/pyrias and acid regurgitation. With heartburn, patients complain of a burning sensation in the chest, which can radiate to the neck, usually less than one hour after meals and gets worse in the lying position. In regurgitation patients complain that food “returns back into the mouth”, when there is no vomiting.
There are also other symptoms which are very uncomfortable but not very common. They are: dysphagia (difficulty in swallowing), odynophagia (pain when swallowing), coughing, dyspnoea (shortness of breath), hoarseness, earache or gingivitis. In case of complications, ulcers and stenosis or digestive haemorrhage may occur.
The main element necessary in reaching a reflux diagnosis is the patient’s medical history. However, there are situations that may present identical symptoms such as peptic ulcers or gastritis. It is, therefore, sometimes necessary to undergo specific screening tests to confirm the diagnosis: upper gastrointestinal endoscopy, stomach oesophagus and duodenum x-rays, and analysis of the oesophageal pH, among others.
Reflux treatment includes several approaches: medication, surgery in more complicated cases and changing daily eating habits. Taking smaller meals, avoiding food and fizzy drinks (previously mentioned) that are known to cause the problem, not lying down in the first 2-3 hours after a meal and raising the head of the bed (about 15 centimetres) may reduce reflux.
Although gastroesophageal reflux cannot be prevented, the measures described above are very important in minimising symptoms.
This article has been summitted by the Gastroenterology Department at the Hospital Particular do Algarve., with hospitals in Alvor and Gambelas (Faro)
