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gastroesophageal reflux

Gastroesophageal (acid) reflux is a painful condition where the sphincter muscles at the top of the stomach (the gastroesophageal sphincter) do not close properly and stomach acids flows backwards into the oesophagus. This causes sensations of heartburn, a sour taste in the mouth, pains in the middle of the chest, coughing and choking when lying down and asthma symptoms during sleep. Gastroesophageal acid can also reach the larynx, causing laryngitis.

Normally the gastroesophageal sphincter opens to let each bolus of food into the stomach and closes behind it, preventing the acid from flowing back and any small amounts that leak back are neutralised by saliva. When the acid flows back in gastroesophageal reflux, it does so in volumes that are too great for the saliva to neutralise and "burns" the esophageal lining (epithelium) causing the painful sensations. The esophageal epithelium is often damaged by this process.

In multiple sclerosis, gastroesophageal reflux is often caused by a lesion in the medulla oblongata region of the brainstem where the 10th cranial nerve arises.

Gastroesophageal reflux is usually diagnosed from a history of signs and symptoms. A barium meal or pH probe can help to confirm a diagnosis.

Increased stomach pressure exacerbates gastroesophageal reflux by allowing more acid out of the stomach. Increased pressure can be caused by a full stomach, obesity, bending forward, lifting heavy objects, pregnancy and lying down.

Treatments include avoidance of fatty foods, citrus and tomato products, strong spices, drinks that contain caffeine, carbonated drinks, chocolate, mint, alcohol or nicotine. Eating smaller, more frequent meals rather than three large ones helps reduce stomach pressure. Bedtime snacks should also be avoided.

Clearly you cannot avoid lying down but elevating the head of the bed by 6 to 8 inches by placing blocks under the legs of the bed helps gravity to keep what belongs in the stomach, in there. It is also recomended that you avoid lifting heavy objects and bending forward.

Several medications are often prescribed to help this condition including antacids (after meals and at bedtime), Tagamet (Cimetadine), Zantac (Ranitidine), Pepcid (Famotidine), Axid (Nizatidine), Prilosec (omeprazole) and Reglan (Metoclopramide).

Concerns have been raised about the safety of the drug Propulsid (cisapride) that has previously been used as a treatment for gastroesophageal reflux. Links to cardiac problems have been indicated - see this news story.

Gastroesophageal Reflux links:
Managing Acid-Reflux Disorders
Esophageal Reflux - Disease therapies protocol
The Heartburn and Swallowing Center of Atlanta
Gastroesophageal Reflux Disease (Hiatal Hernia and Heartburn)


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