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.

Friday, March 7, 2008

Acid Reflux Relief logoAssessment of esophageal body and gastric function

The presence of poor esophageal body function can impact the likelihood of relief of regurgitation, dysphagia, and respiratory symptoms following surgery and may influence the decision to undertake a partial rather than a complete fundoplication. When peristalsis is absent or severely disordered, many would opt for a partial fundoplication, although recent studies would suggest a complete fundoplication may be appropriate even in this setting. The less favorable response of atypical, compared with typical, reflux symptoms after fundoplication may be related to persistent poor esophageal propulsive function and the continued regurgitation of esophageal contents.
The function of the esophageal body is assessed with esophageal manometry. This is performed with five pressure transducers located in the esophagus. To standardize the procedure the most proximal pressure transducer is located 1 cm below the well-defined cricopharyngeal sphincter. With this method a pressure response along the entire esophagus can be obtained during one swallow. The study consists of recording ten standard wet swallows with 5 mL of water. Amplitude, duration, and morphology of contractions following each swallow are all calculated at the five discrete levels within the esophageal body. The delay between onset or peak of esophageal contractions at the various levels of the esophagus is used to calculate the speed of wave propagation and represents the degree of peristaltic activity.
Esophageal disorders are frequently associated with abnormalities of duodenogastric function. Symptoms suggestive of gastroduodenal pathology include nausea, epigastric pain, anorexia, and early satiety. Abnormalities of gastric motility or increased gastric acid secretion can be responsible for increased esophageal exposure to gastric juice. If not identified before surgery, unrecognized gastric motility abnormalities are occasionally unmasked by an antireflux procedure, resulting in disabling postoperative symptoms. Considerable experience and judgment are necessary to identify the patient with occult gastroduodenal dysfunction. The surgeon should maintain a keen awareness of this possibility and investigate the stomach given any suggestion of problems. Tests of duodenogastric function that are helpful when investigating the patient with GE reflux include gastric emptying studies, gastric acid analysis, 24-hour gastric pH monitoring, and ambulatory bilirubin monitoring of the esophagus and stomach.
Poor gastric emptying or transit can provide for reflux of gastric contents into the distal esophagus. Standard gastric emptying studies are performed with radionuclide-labeled meals. They are often poorly standardized and difficult to interpret. Emptying of solids and liquids can be assessed simultaneously when both phases are marked with different tracers. After ingestion of a labeled standard meal, gamma camera images of the stomach are obtained at 5- to 15-minute intervals for 1.5 to 2 hours.
After correction for decay, the counts in the gastric area are plotted as percentage of total counts at the start of the imaging. The resulting emptying curve can be compared with data obtained in normal volunteers. In general, normal subjects will empty 59% of a meal within 90 minutes.