Complications of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a disease caused by gastric juice backing up into the esophagus causing symptoms such as heartburn, heartburn, nausea, vomiting ... Currently, the treatment of reflux pathology Gastroesophageal reflux has not been focused, so the rate of people suffering from this disease is increasing and the complications are increasingly severe. So is gastroesophageal reflux dangerous and how to diagnose, treat and prevent complications?

1.1 Definition Gastroesophageal reflux disease (GERD) is a condition in which gastric juices, food... in the stomach back up into the esophagus, thereby causing symptoms and complications in the esophagus. . In fact, gastroesophageal reflux is a normal physiological phenomenon until gastric juice backs up into the esophagus excessively, prolonging and gradually causing disease.
Anatomically, the esophagus will be protected by the action of the lower esophageal sphincter and the peristalsis of the esophagus to prevent reflux of substances from the stomach up. However, when these protective structures and mechanisms are weakened or lost function, it is easier for stomach contents to back up into the esophagus.
1.2 Causes Pathological or congenital abnormalities of the esophagus. After surgery on the esophagus. Diaphragmatic hernia. Diseases that slow gastric emptying, increase gastric acid secretion, increase pressure in the stomach or abdomen, and stagnation of food in the stomach. People infected with H. pylori bacteria. Psychological problems such as anxiety, negative thinking, stress... Use of drugs such as: Non-Steroidal Anti-Inflammatory Drugs - NSAIDs, Steroid Anti-Inflammatory Drugs, Anti-Cholinergic Drugs, Calcium Blockers, Theophylline, Nitrin, hormone-containing drugs (Progesteron), tranquilizers, tricyclic antidepressants, Beta-blockers ... People who regularly use alcohol, carbonated drinks or smoke. People who are lazy or do little physical exercise. Overweight, obese or pregnant women. The disease is also hereditary.

2.1. Clinical symptoms in the esophagus
Heartburn, heartburn or belching: Usually occurs after eating full, when lying down for a long time at night... Ợ regurgitation, nausea or vomiting: Sensation of reflux of substances into the esophagus. esophagus and can go up to the mouth and hypopharynx. Difficulty swallowing: Due to gastric juice containing acidic components, it causes edema, swelling and narrowing of the diameter of the esophagus. Sleep disturbances due to gastrointestinal symptoms. Extraesophageal symptoms
Chronic persistent cough. Increased salivation due to gastric acid reflux causes a natural reflex. Asthma . Gastroesophageal reflux causes recurrent pharyngitis or croup. Gastroesophageal reflux causes bad breath, oral discomfort and tooth erosion. Aspiration pneumonia or lobar pneumonia. Chest pain is not caused by the heart. 2.2. Subclinical X-ray of the stomach and esophagus with oral contrast. Gastroduodenal endoscopy. Esophageal manometry is also known as esophageal manometry. Measure pH for 24 hours. Bernstein test. Biopsy or histopathology.

3.1. Erosive esophagitis (EE) This is the most common complication of gastroesophageal reflux disease, encountered in 50% of patients. Caused by gastric juice causing damage to the esophageal mucosa, long-term formation of inflammatory foci, causing chest pain behind the sternum, painful swallowing, difficulty swallowing, nausea, loss of appetite...
3.2 . Esophageal stricture A condition that occurs in about 10% of patients with GERD. When the esophagus is exposed to the acidic gastric juices of the stomach for a long time, it will lead to swelling, edema, inflammation and erosion of the lining of the esophagus. Later, these lesions will become scar tissue and cause narrowing of the esophagus.
The symptoms of heartburn and heartburn will begin to decrease gradually, but the patient will increase in severity of symptoms such as difficulty swallowing, difficulty eating, vomiting a lot, especially with solid foods.
3.3. Esophageal perforation This is the least common complication in people with GERD. When the esophageal mucosa is inflamed, the submucosa is exposed and in turn comes into contact with food and acidic gastric juices. The submucosal organs will also begin to be damaged, the esophageal wall will be deeply damaged and eventually lead to esophageal perforation, causing food and gastric juice to leak into the mediastinum. This is a dangerous complication, but early detection and proper treatment will limit this complication.
3.4. Barrett's esophagus Barrett's esophagus accounts for 8 to 15% of patients with gastroesophageal reflux disease. Due to persistent reflux in some patients, the esophagus after being damaged will begin to regenerate, in some cases the new cells are changed, metaplasia or dysplasia (due to the environment in the food). esophageal varices), causing complications of Barrett's esophagus, which is also considered a precancerous lesion.
Barrett's esophagus has two main types:
Short-segment Barrett's esophagus: Lesions < 3 cm. Long-segment Barrett's esophagus: Lesions ≥ 3 cm. Or Prague classification (histopathologically):
Barrett's esophagus without dysplasia or dysplasia (0.5%): This condition should be followed up by endoscopy every 3 to 5 years. Barrett's esophagus with low-grade dysplasia (10%): Consider treatment or follow-up with endoscopic biopsies every 6 months. Barrett's esophagus with high-grade dysplasia (40 %): Indications for retrograde esophageal mucosal resection or esophagectomy. 3.5. Esophageal cancer
The most common is esophageal adenocarcinoma, which usually occurs after the stage of Barrett's esophagus with high-grade dysplasia. Esophageal adenocarcinoma is common in people over 50 years old, causing esophageal bleeding, more pain, weight loss, darkening of the skin... Patients with esophageal adenocarcinoma have a high mortality rate with The survival rate in the next 3 years (from the time of diagnosis) is 5%.
3.6. Complications on the respiratory tract
Manifested by symptoms of extraesophageal reflux, due to the amount of food and gastric juices being pushed up into the esophagus, through the vocal cords and into the trachea. Since then, the patient will have symptoms of chronic cough, sore throat, recurrent laryngitis, bronchial asthma, tooth erosion...

4.1. Non-pharmacological treatments Change your diet
Maintain an appropriate weight. Limit sour foods or fruits, fatty or greasy foods ... Limit the use of coffee, alcohol or carbonated drinks... Divide the menu into several meals eat small. Do not lie down immediately after eating or do not overeat. Lifestyle changes
Elevate your head when lying down from 10 to 15 cm or use an anti-reflux pillow when lying down. Limit the use of clothes that are too tight. Stop smoking. Reduce anxiety, stress, stress ... by meditating, practicing Yoga, listening to relaxing music... Gentle exercise. 4.2. Drug treatment Proton pump inhibitors (PPIs): Omeprazole, Esomeprazole, Pantoprazole, Lansoprazole, Rabeprazole, Dexlansoprazole... The duration of treatment can last from 4 to 12 weeks. Acid neutralizing drugs: Maalox, Gastropulgite, Alusi... Alginate: Gaviscon Histamine H2 receptor antagonists: Ranitidine, Zantac, Tagamet... Drugs acting on esophageal motility (Prokinetics): Metoclopramide, Baclofen, Domperidone ... 4.3. Surgical treatment in gastroesophageal reflux disease Surgical treatment is indicated when medical therapy fails or the patient does not want to take the drug for a long time.
Current popular treatment methods such as endoscopic suture of the esophageal sphincter, esophageal surgery and Nissen reconstruction, use a magnetic device to turn off the esophageal sphincter.
The consequences of gastroesophageal reflux will be very severe if the patient is not diagnosed early and treated properly. Therefore, when detecting any symptoms related to gastrointestinal diseases in general and gastroesophageal reflux disease in particular, patients or relatives should immediately go to a medical facility for examination and treatment. treated by medical professionals.