Tuesday, 26 November 2013

Gastro-esophageal reflux disease (GERD)- The Causes

The prevalence of upper gastrointestinal (GI) diseases is increasing in subjects aged 65 years and over. Pathophysiological changes in esophageal functions that occur with aging may, at least in part, be responsible for the high prevalence of
1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3.  H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4.  Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)
I.  Gastro-esophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD), also known as gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease, is defined as a chronic condition of liquid stomach acid refluxing back up from the stomach into the esophagus, causing heartburn. According to the study of “Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.” by DeVault KR, Castell DO; American College of Gastroenterology, GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.
1. Slower in emptying of the stomach after eating
Most uncommon causes of Gastroesophageal reflux disease (GERD) is due to the distention of the stomach with food over prolonged period of time that can lead to reflux. Approximately 20% of Gastroesophageal reflux disease (GERD) are caused the reason above.
2. Cardia
Cardia is the area between the part of the stomach and the esophagus. It is angle where the esophagus enters the stomach and acts as a valve to prevent foods and others to reflux back to the esophagus. If the cardia is not functioning well, it can cause Gastroesophageal reflux disease (GERD with burning sensation of the esophagus.
3. Esophageal contractile defection
If the esophageal contraction fails to performed its function of proper swallowing food, it may not generate enough waves of contractions to push the foods down to the stomach after swallowing and the acid back into the stomach.
4. Hiatal hernia
Hiatal hernia is a condition of a portion of the stomach protrudes upward into the chest, through a tear or weakness in the diaphragm. According to the study of Nocturnal Reflux Episodes Following the Administration of a Standardized Meal. Does Timing Matter?Michael Piesman, M.D.; Inku Hwang, M.D.; Corinne Maydonovitch, B.S.; Roy K.H. Wong, M.D, posted in Medscape news Today, researchers found that GERD patients consuming a late-evening meal had significantly greater supine acid reflux compared to when they consumed an early meal, especially in overweight patients, and in patients with esophagitis or HH. These findings support the recommendations to our GERD patients to eat dinner early and to lose weight.
5. Obesity
Obesity increase the risk of Gastroesophageal reflux disease (GERD). In a sudy of The association between gastroesophageal reflux disease and obesity.” by Friedenberg FK, Xanthopoulos M, Foster GD, Richter JE., the authors wrote that weight loss, through caloric restriction and behavioral modification, has been studied infrequently as a means of improving reflux. Bariatric surgery and its effects on a number of obesity-related disorders have been studied more extensively. Roux-en-Y gastric bypass (RYGB) has been consistently associated with improvement in the symptoms and findings of GERD.
6. Esophageal mucosa
In a study of Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease.” by Kim JG, Kim YJ, Yoo SH, Lee SJ, Chung JW, Kim MH, Park DK, Hahm KB. posted in US National Library of Medicine National Institutes of Health, researchers found that Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.
7. Medication
The use of medication such as prednisolone acetate ophthalmic suspension, an adrenocortical steroid product can increase the risk of Gastroesophageal reflux disease (GERD).
8. Chronic diseases
Chronic diseases, including cough, pulmonary fibrosis, earache, and asthma are also associated with the higher risk of develop Gastroesophageal reflux disease (GERD)
9. Infection
Infection caused by H. pylori can increase the risk of Gastroesophageal reflux disease (GERD). According to the study of “Helicobacter pylori infection and chronic gastric acid hyposecretion” by EM El-Omar, K Oien, A El-Nujumi, D Gillen, A Wirz, S Dahill, C Williams, JE Ardill, KE McColl posted in Gastroenterology, researchers concluded that in some subjects, chronic H. pylori infection produces a body-predominant gastritis and profound suppression of gastric acid secretion that is partially reversible with eradication therapy. (Gastroenterology 1997 Jul;113(1):15-24).
10. Etc.
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(a) http://www.ncbi.nlm.nih.gov/pubmed/15588798
(1) http://www.ncbi.nlm.nih.gov/pubmed/16001646
(2) http://www.ncbi.nlm.nih.gov/pubmed/22542157

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