The Gastrointestinal System
Synonyms : Esophageal Reflux, Gastroesophageal Reflux, GERD - Gastroesophageal Reflux Disease, Pyrosis
disease (GERD) is a regurgitation of gastric contents into the oesophagus
which takes place after mechanisms which normally prevent this fail (most
important is the lower oesophageal sphincter). This condition is closely
related to sliding hiatus hernia but can happen without the hiatus hernia, and
the hiatus hernia doesn’t always include reflux.
Hiatus hernia is a sliding of the gastro-oesophageal junction through the diaphragm
into the thoracic cavity. The aetiology is unknown but obesity, pregnancy and
occasionally ascites (fluid accumulated in the abdominal cavity) may be
important factors. The condition is common, occurring in up to 30% of normal
adults and 50% of aged individuals. The majority of individuals with a hiatus
hernia have no symptoms and the hernia is of no clinical significance. In a
minority (about 10%) however the hiatus hernia appears to facilitate
gastro-oesophageal reflux presenting with relevant symptoms.
exposure of the lower oesophagus to acid and pepsin results in oesophagitis with the damage to the superficial mucosa, when it is
called erosive oesophagitis. Peptic stricture results from fibrosis (scarring)
that causes narrowing of the oesophageal lumen. Replacement of the normal
squamous epithelium of the oesophagus by columnar intestinal epithelium
containing goblet (mucus producing) cells (Barrett’s
oesophagus) occurs in 2-10% of patients with reflux oesophagitis. This process
is known in pathology as metaplasia and is important because in 2-5% of cases
it can progress to adenocarcinoma (30% of all oesophageal cancers are
adenocarcinoma, the rest being squamous cell carcinoma).
Several factors may promote gastro-oesophageal reflux, such as pregnancy, obesity, ascites, heavy lifting and straining, smoking, alcohol, fatty foods, caffeine, large volume meals.
Clinical features: < BACK TO TOP >
Heartburn (pyrosis), deeply placed burning pain behind the sternum often radiating to the throat, is a characteristic symptom and is produced by the contact of corrosive refluxed material with the inflamed oesophageal mucosa.
characteristically occurs after meals and is aggravated by bending and
straining; can occur on lying down in bed at night.
of gastric content to the mouth during bending, after a large volume meal may
experience transient dysphagia for solids and fluid, usually due to reflex
spasm. More persistent dysphagia for solids suggests development of a peptic
there may be pain on swallowing (odynophagia), which is consistent with more
standing cases oesophageal ulcers may occur and iron deficiency anaemia due to
chronic unnoticed blood loss.
Diagnosis: < BACK TO TOP >
swallow with fluoroscopy (real-time X-ray) is the most widely used initial
test for the diagnosis of oesophageal disease.
presence of hiatus hernia is shown by a barium meal fluoroscopy when the
patient is placed in a lying position with the head down; a leakage of
barium from the stomach into the oesophagus can be seen.
The diagnosis of oesophagitis is made on the visual and biopsy findings at endoscopy; this procedure is especially important to confirm the presence of Barrett’s oesophagus.
Management < BACK TO TOP >
patient should avoid the precipitating factors, and this together with weight
reductions, corrections of diet and stopping smoking alone will relieve
symptoms in about 75% of patients.
patient should sleep in a more upright position (e.g., on two pillows), and
late night meals avoided to reduce reflux during sleep.
preferably liquid preparations, will reduce the heartburn, and can be used as
needed; however they are unsuitable for regular prolonged treatment due to
possible role of aluminium from antacids in degenerative brain disease
(dementia) and osteoporosis.
antagonists (ranitidine [Zantac], nizatidine [Tazac] and famotidine [Pepcidine,
Amfamox]) or proton pump inhibitors (omeprazole [Losec] and lansprazole [Zoton])
will reduce acid and pepsin secretion in the stomach, but do not prevent the
antagonists (metoclopramide [Maxolon, Pramin] and domperidone [Motilium])
increase the contraction of the lower oesophageal sphincter as well as promote
Surgical treatment (antireflux surgery) is carried out in selected cases of sliding hiatus hernia with severe symptomatic reflux oesophagitis that does not respond to above-mentioned measures.
Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP >
Nutrition that alleviate or prevent heartburn :-
Herbs < BACK TO TOP >
Herbs that alleviate or prevent heartburn :-Aloe vera (Aloe)
Anethum graveolens (Dill)
Berberis vulgaris (Barberry)
Cinnamomum zeylanicum (Cinnamon quills)
Gentiana lutea (Gentian)
Hydrastis canadensis (Golden Seal)
Mentha piperita (Peppermint)
Chillis help to alleviate Heartburn. research
(source : -)
7 April 2010
10 December 2004 - International Human Rights Day
World No-Tobacco Day
World Health Day
speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails