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Acid Reflux Disease

Posted Dec 19 2009 6:47pm
Acid reflux or Gastroesophageal reflux (GERD) disease  occurs when the acid rich liquid content of the stomach regurgitates into the esophagus. This acid-rich liquid can inflame and damage the lining of your esophagus. The refluxed liquid may also contain bile that that has backed-up into the stomach from the small intestine (duodenum).

The stomach acid is the most harmful component of the refluxed liquid. Although bile may damage your esophagus, the extent of the damage is not as completely understood as the damaging effects of stomach acid.

Unfortunately, acid reflux is a chronic condition. There is no acid reflux cure. Even after you receive treatment for acid reflux disease and your esophagus heals, the symptoms of acids reflux will return, and the damage will reoccur.

Acid reflux symptoms
There is not a clear-cut cause of acid reflux. The causes of acid reflux can vary from person to person. Some people simply produce a higher amount of stomach acid, but in most cases the following factors contribute to acid reflux in patients:

•Obesity - Excess weight puts extra pressure on your stomach and diaphragm, the large muscle that separates your chest and abdomen, forcing open the lower esophageal sphincter and allowing stomach acids to back up into your esophagus. Eating very large meals or meals high in fat may cause similar effects.

•Pregnancy - Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. This hormone relaxes many of your muscles, including the lower esophageal sphincter.

•Asthma - Doctors aren't certain of the exact relationship between asthma and heartburn. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen, triggering regurgitation of stomach acid into your esophagus. Some asthma medications that widen (dilate) airways may also relax the lower esophageal sphincter and allow reflux. Or it's possible that the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of the digestive juices from your esophagus and pharynx, damaging lung airways.

•Diabetes - One of the many complications of diabetes is gastroparesis, an uncommon disorder in which your stomach takes too long to empty. Left in your stomach too long, stomach contents can regurgitate into your esophagus and cause heartburn.

•Peptic ulcer - An open sore or scar near the valve (pylorus) in the stomach that controls the flow of food into the small intestine can keep this valve from working properly or can obstruct the release of food. Food doesn't empty from your stomach as fast as it should, causing stomach acid to build up and back up into your esophagus.

•Delayed stomach emptying - The most common time for acid reflux is during the day, after you eat. Studies show reflux commonly occurs at these times as a result of LES relaxations caused by distention of the stomach with food. In addition to diabetes or an ulcer, abnormal nerve or muscle functions can delay emptying of your stomach, causing acid backup into the esophagus.

•Connective tissue disorders - Diseases such as scleroderma that cause muscular tissue to thicken and swell can keep digestive muscles from relaxing and contracting as they should, allowing acid reflux.

•Zollinger-Ellison syndrome - One of the complications of this rare disorder is that your stomach produces extremely high amounts of acid, increasing the risk of acid reflux.

•Lower esophageal sphincter (LES) - The LES is a specialized ring of muscle that surrounds the end of the esophagus joined to the stomach. Your LES opens when food or saliva is swallowed, but closes to prevent reflux. Acid reflux occurs when your LES abnormally relaxes or contracts weakly. Extended relaxation or weak contractions allow more acid to travel back up the esophagus.

•Esophageal contractions - Swallowing is a key factor in preventing acid reflux. When you swallow, you contract the esophageal muscles. This contraction pushes food, saliva and acid back into your stomach. In certain patients, this contraction is not strong enough to push the acid back into the stomach.

•Hiatal hernia - Hiatal hernias are another contributing factor to acid reflux, although doctors and researchers are not sure how they contribute. Studies show that a majority of patients who suffer from acid reflux also have hiatal hernias.

Studies also indicate that people with hiatal hernias don't always suffer from acid reflux disease. A hiatal hernia occurs when a small part of your upper stomach that attaches to the esophagus is pushed through the diaphragm. This forces the lower esophageal sphincter (LES) to lie in the chest. As a result, your LES is no longer level with your diaphragm. Normally, the pressure exerted by your diaphragm and LES prevents reflux, but after the LES is pushed into the chest, the additive pressure of is decreased.

Hiatal hernias may also contribute to your acid reflux disease because when a hiatal hernia is present, a hernial sac is also present. This hernail sac is separated from your esophagus by the LES and the diaphragm. In certain cases, the hernail sac traps acid coming from your stomach, which means it is easier for the acid to reflux whenever your LES relaxes.

Symptoms of acid reflux oesophagitis
•A painful or burning sensation in the upper abdomen or chest, sometimes radiating to the back (heartburn).

•Difficulties breathing and suffering from hoarseness because the refluxed fluid irritates the larynx and respiratory tract.

•Excess belching is common.

When does acid reflux occur?
•After eating a large or fatty meal.

•After drinking alcohol.

•Lying down, bending over or bending and lifting.

•After smoking.

•After eating chocolate, caffeine, onions, spicy foods, mint and some medications.

•Lying down soon after eating.

•After taking tranquilizers, such as benzodiazepines including diazepam (Valium) and alprazolam (Xanax).

•After taking Theophylline (Elixophyllin), an asthma medication. In some cases, acid reflux symptoms may have no apparent cause.

How does acid reflux affect you?
•Acid reflux is unpleasant and can greatly affect your lifestyle.

•Acid reflux symptoms can lower your quality of life.

•Prolonged exposure to refluxed acid leads to oesophagitis (inflammation of the oesophagus), and in extreme cases can cause scar tissue that makes it difficult or impossible to swallow.
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