Gastroesophageal reflux disease (GERD) occurs when stomach acid returns up into the esophagus and causes irritation. It is common for people to experience acid reflux occasionally, but GERD is when it occurs at least twice a week or more severely once a week. Risk factors include obesity, pregnancy, smoking, and certain medications. Symptoms include heartburn, nausea, coughing, and sore throat. Diagnosis is usually based on symptoms, but tests like endoscopy or pH monitoring can be done. Treatment involves lifestyle changes like losing weight, avoiding foods and drinks that trigger symptoms, and medications to reduce acid production. Surgery may be an option for severe cases that do not improve with other treatments.

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UNIVERSIDAD TECNICA DE MACHALA
ACADEMIC UNIT OF CHEMICAL
SCIENCES AND HEALTH
MEDICINE SCHOOL
ENGLISH
GERD
STUDENTS
William Cruz
Kevin Herrera
TEACHER:
Mgs. Barreto Huilcapi Lina Maribel
CLASS:
EIGHTH SEMESTER ‘’A’’
Machala, El Oro
2018

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GERD
Definition
Gastroesophageal reflux disease occurs when stomach acid usually returns to the tube
that connects the mouth to the stomach (esophagus). This flow in the opposite
direction (acid reflux) can irritate the lining of the esophagus.
Many people suffer from acid reflux every so often. Gastroesophageal reflux disease
can be mild acid reflux, which occurs at least twice a week, or moderate to severe
acid reflux, which occurs at least once a week.
Most people can control the discomfort of gastroesophageal reflux disease with
changes in lifestyle or over-the-counter medications. However, some people with
gastroesophageal reflux disease may need stronger medications or surgery to relieve
symptoms.

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Etiology
When you eat, food passes from the throat to the stomach through the esophagus. A
ring of muscle fibers in the lower part of the esophagus prevents the swallowed food
from rising again. These muscle fibers are called the lower esophageal sphincter
(LES).
When this muscular ring does not close well, the contents of the stomach can be
returned to the esophagus. This is called reflux or gastroesophageal reflux. Reflux can
cause symptoms. Strong gastric acids can also damage the lining of the esophagus.
Among the risk factors for the development of reflux are:
 Consumption of alcohol (possibly)
 Hiatus hernia (a condition in which part of the stomach passes over the
diaphragm, the muscle that separates the thorax and the abdominal cavity)
 Obesity
 Pregnancy
 Scleroderma
 Smoking
 Recline less than 3 hours after eating
 Gastric acidity and gastroesophageal reflux may be caused or made worse by
pregnancy.
The symptoms may also be caused by certain medications, such as:
 Anticholinergics (for example, for dizziness)
 Bronchodilators for asthma
 Calcium channel blockers for high blood pressure
 Dopaminergic drugs for Parkinson's disease
 Progestin for abnormal menstrual bleeding or birth control
 Sedatives for insomnia or anxiety
 Tricyclic antidepressants

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Signs and symptoms
The common symptoms of GERD are:
 Feel that the food gets stuck behind the sternum
 Gastric acidity or burning pain in the chest
 Nausea after eating
The less common symptoms are:
 Return the food (regurgitation)
 Cough or wheezing
 Difficulty swallowing
 Hiccup
 Hoarseness or changes in the voice
 Sore throat
Symptoms can get worse when you bend or lie down or after eating. The symptoms
can also be worse at night
Diagnosis
For the diagnosis of GERD, the clinical history of the patient is sufficient: presence
of heartburn, with or without regurgitation, which impairs quality of life, which
appears after eating, when lying down or stooping, which yields with alkalines and is
prevented with antisecretory drugs . Oral endoscopy is often performed in patients
with GERD but is not necessary for diagnosis. Through this exploration we can detect
the presence of hiatus hernia and complications such as esophagitis, stenosis and
Barrett's esophagus, as well as rule out other diseases. It should be practiced when
there is alarm data (difficulty swallowing, anemia, weight loss) that suggest a
complication, when the patient's symptoms are not as typical, as previously
mentioned, or they do not improve with antisecretory, or there are other Clinical-
analytical data that suggest that other diseases may exist. Another reason for
performing endoscopy may be when the surgical intervention of GERD is indicated,
so that the surgeon has more information about the state of the disease.

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24-hour ambulatory esophageal pH-metry is the best method to know the time that
acid gastric juice is in contact with the esophageal mucosa and to verify if the
patient's symptoms are related to episodes of GOR.
It consists of introducing a thin plastic probe through the nostrils to the lower
esophagus. The probe has sensors sensitive to changes in pH. Episodes of GER are
detected by lowering the pH in the lower esophagus. The patient, with the probe
connected to a recording device placed on a belt, is incorporated into his routine life
for 24 hours. The reading of the record will inform us of the existence of episodes of
GER: number of episodes, duration of the same, relation with the ingestion, with the
posture (lying, crouched or standing) and with the symptoms that it refers during this
time, being able A relationship between the episode of GOR (lowering of the pH in
the esophagus) and, for example, chest pain is evident. PHmetry will be indicated in
patients with clinical diagnosis of GERD but without response to treatment, in those
who are going to undergo surgical treatment of GER or in those who present atypical
symptoms such as chest pain, bronchospasm or dysphonia.
Treatment
Measurements:
 If you are overweight or obese, in many cases, losing weight can help.
 Elevate the head of the bed if symptoms worsen at night.
 Dine 2 to 3 hours before going to sleep.
 Avoid drugs such as acetylsalicylic acid (aspirin), ibuprofen (Advil, Motrin)
or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve
pain.
Take all your medications with plenty of water. When your provider gives you a new
medication, be sure to ask if it will make your heartburn worse.
You can use over-the-counter antacids after meals and at bedtime, although the relief
may not last long. Common side effects of antacids include diarrhea or constipation.

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Other over-the-counter and prescription medications can treat GERD. They act more
slowly than antacids, but give you longer relief. The pharmacist, doctor or nurse can
tell you how to take them.
 Proton pump inhibitors (PPIs) decrease the amount of acid produced in the
stomach.
 Blockers (antagonists) of H2 decrease the amount of acid released in the
stomach.
Anti-reflux surgery may be an option for people whose symptoms do not go away
with changes in lifestyle and medications. Gastric acidity and other symptoms should
improve after surgery. However, you may still need to take medications for heartburn.
Likewise, there are new therapies for reflux that can be carried out by means of an
endoscope (flexible probe that is passed through the mouth to the stomach).
Prevention
Avoiding the factors that cause heartburn can help prevent symptoms. Obesity is
linked to GERD. Maintaining a healthy body weight can help prevent the disease.
Bibliography
 Dent J, Brun J, Fendrick AM, Fennerty MB, Janssens J, Kahrilas PJ, Lauritsen
K, Reynolds JC, Shaw M, Talley NJ. An evidence based appraisal of reflux
disease management- the Genval Workshop Report. Gut 1999; 44: S1-S16.
 Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Mon treal
definition and classification of gastroesophageal reflux disease: a global
evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920.
 Guyatt GH, Oxman AD, Kunz R, Jaeschke R, Helfand M, Liberati A, Vist
GE, Schünemann HJ, for the GRADE working group. Rating quality of
evidence and strength of recommendations: Incorporating considerations of
resources use into grading recommendations. BMJ 2008; 336: 1170-1173.