GERD: Symptoms, Causes, and Treatment Insights - Gastroenterology and Hepatology

Gastroesophageal reflux and the gastroesophageal junction?

Hello Doctor: I have a few questions I would like to ask you.

1.
Gastroesophageal reflux disease (GERD) generally refers to the esophagus being affected by stomach acid.
However, my symptoms include discomfort in the stomach (a slight heaviness).
This situation should be below the gastroesophageal junction, and stomach acid has not refluxed into the esophagus.
Does this still count as GERD?
2.
Three months ago, I experienced chest tightness, but that symptom is no longer present.
Currently, I take Pantoloc or Nexium in the morning, and I feel fine until the afternoon.
However, in the afternoon or evening, I experience some heaviness and bloating in my stomach.
Does this indicate that my GERD has not yet recovered?
3.
In terms of human anatomy, could you roughly indicate the location of the gastroesophageal junction?
4.
In a gastroscopy report from January, it was noted that there is erosion in the stomach.
What could be the cause of this? If this condition is to heal, it would require reducing stomach acid.
Would taking PPIs or Gelusil effectively suppress stomach acid in this case? Thank you.

Michael, 40~49 year old female. Ask Date: 2010/05/13

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello,
1.
Gastroesophageal reflux disease (GERD) is assessed both by symptoms and through endoscopic diagnosis.
It is often accompanied by gastritis or peptic ulcers, and therefore, gastric symptoms are commonly present.

2.
For GERD, mild cases typically require treatment for four months, while severe cases may necessitate medication for up to a year.
It is important to note that this condition is prone to recurrence.

3.
Generally speaking, visceral nerves do not correspond to a single nerve linked to one specific location, so the location of abdominal pain cannot definitively indicate which organ or area is affected.

4.
Severe gastritis may lead to ulceration.
Factors such as body weight, irritating foods, medications, or stress are all related.
The acid suppression capability of proton pump inhibitors (PPIs) far exceeds that of Gelusil.

Wishing you health,
Dr.
Chi-Feng Chen, Taoyuan Hospital, Department of Health

Reply Date: 2010/05/13

More Info

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backflow of stomach contents, particularly acid, into the esophagus. This can lead to a variety of symptoms, including heartburn, regurgitation, chest pain, and difficulty swallowing. Understanding GERD involves recognizing its symptoms, causes, and treatment options.

Symptoms of GERD
1. Heartburn: A burning sensation in the chest, often after eating or when lying down.

2. Regurgitation: The sensation of acid backing up into the throat or mouth.

3. Dysphagia: Difficulty swallowing, which can occur if the esophagus is inflamed or narrowed.

4. Chest Pain: This can mimic heart-related issues, making it important to differentiate between the two.

5. Chronic Cough or Sore Throat: Often due to acid irritating the throat.

6. Nausea: Some individuals may experience nausea, particularly after eating.

Causes of GERD
GERD can be caused by several factors, including:
- Lower Esophageal Sphincter (LES) Dysfunction: The LES is a muscle that acts as a valve between the esophagus and stomach. If it relaxes inappropriately, acid can reflux into the esophagus.

- Hiatal Hernia: A condition where part of the stomach pushes through the diaphragm into the chest cavity, which can affect the function of the LES.

- Obesity: Increased abdominal pressure can push stomach contents back into the esophagus.

- Pregnancy: Hormonal changes and increased abdominal pressure can contribute to GERD.

- Diet and Lifestyle: Certain foods (like spicy or fatty foods), alcohol, caffeine, and smoking can exacerbate GERD symptoms.

Treatment Insights
1. Lifestyle Modifications:
- Weight loss if overweight.

- Avoiding trigger foods and beverages.

- Eating smaller, more frequent meals.

- Not lying down immediately after eating.

- Elevating the head of the bed.

2. Medications:
- Proton Pump Inhibitors (PPIs): Such as Pantoprazole (Pantoloc) and Esomeprazole (Nexium), which reduce stomach acid production.

- Antacids: Such as Gelusil, which neutralize stomach acid and provide quick relief.

- H2 Receptor Antagonists: These can also reduce acid production but are generally less effective than PPIs.

3. Surgery: In severe cases where lifestyle changes and medications do not provide relief, surgical options such as fundoplication may be considered.

Addressing Your Questions
1. Symptoms and GERD Diagnosis: Your symptoms of gastric discomfort without acid reflux into the esophagus may still be related to GERD, particularly if the discomfort is due to acid irritation in the stomach or lower esophagus. GERD can manifest in various ways, and not all symptoms involve classic heartburn.

2. Ongoing Symptoms: The fact that you experience discomfort later in the day could indicate that your GERD is not fully controlled yet. It’s possible that the timing of your medication (morning dosing) may not provide adequate coverage for the entire day. Discussing this with your healthcare provider may lead to adjustments in your treatment plan.

3. Location of the Cardia: The cardia is the area of the stomach closest to the esophagus, located just below the lower esophageal sphincter (LES). It is where the esophagus connects to the stomach.

4. Gastric Mucosal Damage: The presence of "破皮" (erosions) in the stomach lining could be due to several factors, including chronic acid exposure, use of non-steroidal anti-inflammatory drugs (NSAIDs), or infections like Helicobacter pylori. PPIs and antacids can help protect the stomach lining by reducing acid production, allowing for healing.

In summary, GERD is a multifaceted condition that can present with various symptoms and requires a comprehensive approach to management. If you continue to experience symptoms despite treatment, it is essential to follow up with your healthcare provider for further evaluation and potential adjustments to your treatment plan.

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