Can Relaxed Gastroesophageal Junction Be Permanently Treated?

Can gastroesophageal reflux caused by lower esophageal sphincter laxity be cured?

Hello, doctor.
I started experiencing bloating and belching at the age of eighteen.
After seeing a doctor, the symptoms recurred after six months.
An endoscopy revealed mild gastritis and gastroesophageal reflux disease (GERD).
The doctor I consulted said the symptoms were mild and that medication would help.
During the four months of medication, I had no symptoms at all.
I thought I was cured, but after stopping the medication, I no longer had bloating but developed difficulty swallowing and a sore throat.
I underwent another endoscopy and found that the lower esophageal sphincter was relaxed.
The doctor prescribed Nexium, Domperidone, and Panzolec, but aren't these medications just suppressing stomach acid? The lower esophageal sphincter is still in a relaxed state, right? I searched online and found that a relaxed lower esophageal sphincter cannot be treated with medication, only through surgery.
Does this mean I will have to take medication for the rest of my life?

Lily, 20~29 year old female. Ask Date: 2019/03/15

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Gastroesophageal reflux disease (GERD) is primarily related to the relaxation of the lower esophageal sphincter (LES).
The degree of LES relaxation can lead to varying levels of gastroesophageal reflux.
GERD is a condition that is prone to recurrence and is closely associated with dietary habits, as well as the extent of LES relaxation.

Reply Date: 2019/03/15

More Info

The symptoms you are experiencing, including abdominal bloating, belching, swallowing difficulties, and throat pain, are indeed concerning and can be attributed to a relaxed gastroesophageal junction (GEJ) and gastroesophageal reflux disease (GERD). The GEJ is the area where the esophagus meets the stomach, and when it is relaxed or dysfunctional, it can lead to reflux of stomach contents into the esophagus, causing discomfort and various symptoms.

1. Understanding the Symptoms: Your symptoms of bloating and belching can be exacerbated by the relaxation of the GEJ, which allows stomach acid and contents to flow back into the esophagus. This can lead to inflammation and irritation of the esophagus, resulting in swallowing difficulties and throat pain. The transient relief you experienced while on medication suggests that the medications were effective in controlling the symptoms but did not address the underlying issue of the relaxed GEJ.

2. Medication and Its Limitations: Medications like Nexium (a proton pump inhibitor) and Domperidone (which helps with gastric emptying) can help manage symptoms by reducing stomach acid production and improving gastric motility. However, they do not correct the anatomical issue of a relaxed GEJ. This means that while medications can provide symptom relief, they do not offer a permanent solution to the underlying problem. As you noted, many sources indicate that a relaxed GEJ is not typically treatable with medication alone and may require surgical intervention if symptoms persist or worsen.

3. Surgical Options: Surgical options, such as fundoplication, can be considered if conservative management fails. This procedure involves wrapping the top of the stomach around the lower esophagus to reinforce the GEJ and prevent reflux. It is important to discuss the potential benefits and risks of surgery with your healthcare provider, as well as the likelihood of symptom improvement.

4. Long-term Management: If surgery is not an option or if you prefer to avoid it, long-term medication may be necessary. Lifestyle modifications can also play a significant role in managing symptoms. These include dietary changes (avoiding trigger foods), eating smaller meals, not lying down immediately after eating, and maintaining a healthy weight.
5. Monitoring and Follow-up: Regular follow-up with your healthcare provider is essential to monitor your condition and adjust treatment as needed. If you experience worsening symptoms or new issues, further evaluation may be warranted.

6. Psychological Impact: It is also worth noting that chronic gastrointestinal issues can lead to anxiety and stress, which can further exacerbate symptoms. If you find that your symptoms are affecting your mental health, consider discussing this with your doctor, who may recommend seeing a mental health professional.

In conclusion, while medications can provide temporary relief from symptoms associated with a relaxed gastroesophageal junction, they do not offer a permanent solution. Surgical options may be necessary for long-term management, and lifestyle modifications can significantly help in controlling symptoms. Regular follow-up with your healthcare provider is crucial to ensure that your treatment plan is effective and to address any new or worsening symptoms.

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