Pathophysiology of Gastroesophageal Reflux DiseaseRecent data support the likelihood that GERD begins in the stomach. Fundic distention occurs because of overeating and delayed gastric emptying secondary to the high-fat Western diet. The distention causes the sphincter to be taken up by the expanding fundus, exposing the squamous epithelium with the high-pressure zone, which is the distal 3 cm of the esophagus, to gastric juice. Repeated exposure causes inflammation of the squamous epithelium, columnarization, and carditis. This is the initial step and explains why in early disease the esophagitis is mild and commonly limited to the very distal esophagus. The patient compensates by increased swallowing, allowing saliva to bathe the injured mucosa and alleviate the discomfort induced by exposure to gastric acid. Increased swallowing results in aerophagia, bloating, and repetitive belching. The distention induced by aerophagia leads to further exposure and repetitive injury to the terminal squamous epithelium and the development of cardiac-type mucosa. This is an inflammatory process, commonly referred to as carditis and explains the complaint of epigastric pain so often registered by patients with early disease. The process can lead to a fibrotic mucosal ring at the squamocolumnar junction and explains the origin of a Schatzki ring. Extension of the inflammatory process into the muscularis propria causes a progressive loss in the length and pressure of the distal esophageal high-pressure zone associated with an increased esophageal exposure to gastric juice and the symptoms of heartburn and regurgitation. The loss of the barrier occurs in a distal to proximal direction and eventually results in the permanent loss of LES resistance and the explosion of the disease into the esophagus with all the clinical manifestations of severe esophagitis. This accounts for the observation that severe esophageal mucosal injury is almost always associated with a permanently defective sphincter. At any time during this process and under specific luminal conditions or stimuli, such as exposure time to a specific pH range, intestinalization of the cardiac-type mucosa can occur and set the stage for malignant degeneration.
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.
