Gastroesophageal Re-flux Disease’s Symptoms, Diagnostic tools, and Treatment Plan

Gastroesophageal reflux disease (GERD) is a digestive disorder which refers to the upward movement of stomach content into esophagus, caused by the less functionality of lower esophageal sphincter. The food passes from the esophagus into the stomach and the lower esophageal sphincter prevents its backward flow. It occurs when the lower esophageal sphincter becomes weak and cannot prevent the upward flow of the stomach acid or food content. The backward flow of acid or stomach content causes irritation and sometimes inflammation of the esophageal lining which is termed as heartburn. The major risk factors for GERD are obesity, slow stomach emptying, pregnancy, and hiatal hernia. A hiatal hernia is a bulging-up of the stomach which is thought to have a contribution in casing the weakness of lower esophageal sphincter.

Associated Signs and Symptoms
GERD is a digestive complication in which irritation of esophageal wall occurs with acid reflux from the stomach due to weakening lower esophageal sphincter. The upward flow of stomach acid causes multiple symptoms which include heartburn, dysphagia, and food or liquid regurgitation (Badillo, 2014). It can also exhibit respiratory symptoms such as chronic cough, worsening asthma, and laryngitis (Badillo, 2014). Acid reflux at night aggravates the symptoms which can cause sleep disturbances. The acid reflux from the stomach causes burning pain in the chest due to the irritation of esophageal wall which is termed as Heartburn. Swallowing difficulties arise with the backing up of acid from the stomach; it usually occurs in severe cases. Chronic cough and asthma can be induced directly when acid approached the airways or indirectly by neurologic inflammation. The acid reflux can cause the irritation of nerves present at the esophageal end which mediates the bronchial reactivity and decreases expiratory flow (Ates & Vaezi, 2014).

Screening Assessment Tools
Screening of the patients' symptoms is required before conducting further diagnostic testing to prevent excessive tests. A comprehensive history of the patient's present illness is a first step in assessing the nature of the disease. Through the patient’s history the onset of heartburn, swallowing difficulty and food or liquid regurgitation can be helpful in determining the disease. Physical examinations regarding the presence of physical symptoms such as chest pain, chronic cough, and laryngitis can also assist a healthcare provider in assessing the root cause of the present illness. Furthermore, the diagnostic testing of the patient is required for the final evaluation of patient condition.

Recommended Diagnostic Tests
For the diagnosis of GERD, ambulatory acid probe test is performed to measure pH or amount of acid that flows into the esophagus from the stomach during a 24-hour period. X-ray is done after swallowing barium liquid which coats the lining of throat, stomach, and intestine, which enables the healthcare provider to observe the problems in the organ. Endoscopy of the esophagus and the upper part of the stomach is performed by inserting a tiny camera through a long and thin tube, to inspect the inner lining of the digestive tract for possible damage. Manometry is another process through which the rhythmic muscle contractions of esophagus are observed (Katz, Gerson & Vela, 2013).

Pharmacological Treatment Plans
The treatment provided for GERD is based on reducing acid production, acid neutralization and controlling the movement of the lower esophageal sphincter. For these purpose antacids, H-2 receptor blockers and proton pump inhibitors are recommended (Katz, Gerson & Vela, 2013). Antacids neutralize the acid, while H-2 receptor blockers reduce the acid production. Proton pump inhibitors also decrease the acid production, therefore, when the acid backs up into esophagus it becomes less irritating. However, in severe cases, laparoscopic surgery is recommended to prevent reflux by wrapping the stomach around the esophageal sphincter.

Non-Pharmacological Treatment Plan
Nonpharmacologic interventions require modification in lifestyle and eating habits, here I want to share important steps regarding lifestyle changes to reduce the symptoms of gastroesophageal reflux disease which are as follows:
  1.  First of all, maintaining a healthy weight is necessary, thereby, if you are obese then you need to reduce your weight.
  2.  Secondly, you have to reduce the production of acid, the production of acid can be reduced through consuming ginger, vegetables, banana, melons, oatmeal, and so on.
  3.       Avoid alcohol and smoking, from your lifestyle these all both things are unhealthy for your gastroesophageal reflux diseases, and consumption of these things can produce extreme adverse effects. Besides it, avoid junk and spicy food, chocolate, caffeine, carbonated beverages, because these all foods increase the acid and ultimately lead reflux in the stomach (Ness-Jensen, Hveem, El-Serag & Lagergren, 2016). 
  4.       A small meal is the best option to reduce the symptoms of gastroesophageal reflux disease because a large meal may enhance the pressure of the stomach and because of pressure reflux occur in the stomach.
  5.       Do not lie down after having a meal, and most importantly, dinner should be consumed three hours before going in bed.
These lifestyle changes may help you in preventing and improving gastroesophageal reflux disease.

References
Ates, F., & Vaezi, M. (2014). Insight into the relationship between gastroesophageal reflux disease and asthma. Gastroenterology & Hepatology, 10(11), 729–736. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395714/
Badillo, R. (2014). Diagnosis and treatment of gastroesophageal reflux disease. World Journal of Gastrointestinal Pharmacology and Therapeutics, 5(3), 105. http://dx.doi.org/10.4292/wjgpt.v5.i3.105
Katz, P., Gerson, L., & Vela, M. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology, 108(3), 308-328. http://dx.doi.org/10.1038/ajg.2012.444
Ness-Jensen, E., Hveem, K., El-Serag, H., & Lagergren, J. (2016). Lifestyle Intervention in Gastroesophageal Reflux Disease. Clinical Gastroenterology And Hepatology, 14(2), 175-182.e3. doi: 10.1016/j.cgh.2015.04.176

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