Gastroesophageal reflux
The backflow or reflux of gastric and duodenal contents into the esophagus and past the lower esophageal sphincter (LES), without associated belching or vomiting, is called gastroesophageal reflux. Reflux may or may not cause symptoms or pathologic changes. Persistent reflux may cause reflux esophagitis (inflammation of the esophageal mucosa). The prognosis varies with the underlying cause.
Causes
The function of the LES—a high-pressure area in the lower esophagus, just above the stomach—is to prevent gastric contents from backing up into the esophagus. Normally, the LES creates pressure, closing the lower end of the esophagus, but relaxes after each swallow to allow food into the stomach.
Reflux occurs when LES pressure is deficient or when pressure within the stomach exceeds LES pressure.
The amount of time the reflux is in contact with the esophagus as well as the potency of the reflux relates to esophageal damage. Gastroesophageal reflux can also be related to delayed gastric emptying resulting from partial gastric outlet obstruction or gastroparesis. It may also be attributed to an abnormal esophageal clearance. In this instance, acid isn’t cleared and neutralized by esophageal peristalsis and salivary bicarbonates, as it is normally.
Clinical TipGastroesopha-geal reflux may also be related to atypical symptoms, such as chronic cough, sore throat, asthma, and laryngitis, and atypical chest pain.
Predisposing factors include the following:
pyloric surgery (alteration or removal of the pylorus), which allows reflux of bile or pancreatic juice
long-term nasogastric (NG) intubation (more than 5 days)
any agent that lowers LES pressure, such as food, alcohol, cigarettes, anticholinergics (atropine, belladonna, and propantheline), and other drugs (morphine, diazepam, and meperidine)
hiatal hernia (especially in children)
any condition or position that increases intra-abdominal pressure.
Signs and symptoms
Gastroesophageal reflux doesn’t always cause symptoms. The most common features of this disorder are indigestion and heartburn, which may become more severe 30 to 60 minutes after meals and on reclining and with vigorous exercise, bending, or lying down and which may be relieved by antacids or sitting upright.
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