What is acid reflux relief?

In medically oriented terms, antonyms of the word relief include pain, distress or damage. That links its meaning to both subjective and objective aspects. Subjective, denoting sensations experienced by the sufferer such as pain and objective, meaning physical findings detected by specialists which are either functional distress or organic damage. Actually relief is related to control measures and it quantitatively signifies removal of an unpleasant existence or reduction of its magnitude. The definition of relief, therefore encompasses alleviation of pain, relaxation of distress and healing of damage. Acid reflux on the other hand has two sides; the subjective side (symptoms) which reflects the symptom of heartburn and the objective side (signs) that reflects the functional and/or organic signs of esophageal changes. Acid reflux relief is therefore a broad term that covers all the measures used to control symptoms and signs of acid reflux disease. Normally, the lower esophageal sphincter remains closed except during swallowing. This prevents the passage of food and acid from the stomach into the esophagus. If the lower esophageal sphincter becomes weakened or relaxed, stomach acid may back up into the esophagus. Frequent acid reflux can irritate and inflame the lining of the esophagus, causing symptoms and signs of acid reflux. A better understanding of relief would thus entail knowledge of some aspects of normal structure and function, so that changes in the disease and its control could be easily considered. Actually acid reflux relief involves both preventive and curative measures, and in addition to treatment; orientation with the causes, symptoms and complications of acid reflux are essential for proper management. Acid reflux relief includes: dietary changes,lifestyle modifications, specific medications and surgical operations.Basic knowledge of the underlying causes and progression of acid reflux and answering frequently asked questions about its relief; add to the depth of understanding.

Tuesday, August 7, 2007

Acid Reflux Relief logoHow serious is Barrett's esophagus?

What do you mean by Barrett's esophagus?
Norman Barrett (1903–1979), a British surgeon at St Thomas' Hospital, first described specified changes in the appearance of the esophageal lining of patients with acid reflux disease in 1950. These changes are in the form of abnormal pink projections extending upwards into the esophagus from the stomach. They represent replacement of the normal cells lining the esophagus with another type of cells peculiar to the stomach or the intestine.

When the stomach contents reflux into the esophagus, its cellular lining is eroded. This damage mainly affects the superficial cells and the deep or basal germinative cells (stem cells) usually survive. In these cells a genetic switch causes them to generate new cells of specialized characteristics that differ from native esophageal cells. The new cells produce mucus and are more resistant to acid. They also differ in shape, being columnar instead of the spindle shaped esophageal cells. They also have some cells which are goblet shaped and are stuffed with mucus. This cellular pattern is similar to intestinal cells and is diagnostic of Barrett's esophagus.

Barrett's esophagus graphics

About 10% of patients with acid reflux disease have Barrett's esophagus. It's usually diagnosed during endoscopy and has specific features.

Endoscopy for Barrett's esophagus

The pink projections characteristic of Barrett's esophagus vary in length, some are short (less than 3cm) and others long (more than 3cm) having higher risk of developing intestinal metaplasia . Proper diagnosis is confirmed by taking a specimen of this abnormal tissue and examining it under the microscope.
The process of replacement of esophageal cells with intestinal tissue (transformation of native cellular pattern with normal tissue of another organ) is called Metaplasia.
Metaplasia usually progresses into Dysplasia, a change in individual cellular features. Abnormalities involve cellular architecture, intracellular infrastructure and nuclei. Cells usually vary in size and shape and their nuclei reveal profound changes. Dysplasia may be low-grade or high-grade and this variety is pre-cancerous, usually complicated with a type of cancer called Adenocarcinoma of the esophagus. About 10% of patients with Metaplasia change into Dysplasia, and 1% of patients with Barrett's esophagus will have the risk of developing cancer.
As Barrett-type intestinal metaplastic cells are under-developed, they don't have normal sensory nerve supply and patients used to suffer from heartburn may not experience it any more. Accordingly, sufferers reporting spontaneous relief of symptoms after a long standing heartburn should be managed with a high index of suspicion.
In Barrett's esophagus It's mandatory to monitor cellular changes frequently. If no Dysplasia is associated endoscopy should be performed every year. When Dysplasia is detected, the opinion of an experienced pathologist is essential to confirm the diagnosis and differentiate between low-grade and high-grade types. In low-grade Dysplasia endoscopy should be repeated every six months to detect any progression. In high-grade Dysplasia, if the patient is at high risk for surgery, endoscopic ablative procedures should be considered. In fit patients surgical excision of the esophagus is the preferred approach, the operation is called esophagectomy.
Photo-dynamic therapy is an endoscopic ablative procedure which involves injecting a photo-sensitizing material followed by delivering red laser light to sensitized cells. Consequently, cells containing the drug are destroyed.
Endoscopic mucosal resection is safer than surgery and involves excision of dysplastic tissue, it also has a diagnostic role as it submits an adequate specimen for proper diagnosis and determining the depth of invasion.

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