Gastro-oesophageal reflux disease (GORD) Part 2
Posted by Eamonn Brady on
Complications
Oesophageal ulcers
Continued and prolonged damage to the oesophageal lining by GORD, if left untreated, can lead to ulcers forming within the tube. These ulcers can bleed and cause pain making swallowing difficult.
Oesophageal stricture
Constant exposure to acid can cause scar tissue to form the lining of the oesophagus. Again, like ulcers, if left untreated, this scar damage will build up causing the oesophagus to narrow causing poor and painful swallowing.
Barrett’s oesophagus
This condition relates to a change, caused by persistent GORD, in those cells which line the oesophageal tube. About 10% of GORD sufferers will develop Barrett’s oesophagus, with diagnosis most common in those aged 50 -70. Whilst the condition does not normally present any symptoms other than reflux, there is a small risk that affected cells may turn cancerous triggering the onset of oesophageal cancer. It is estimated that 1 in 200 people with Barrett’s oesophagus go on to develop cancer each year.
Oesophageal cancer
Certain factors increase the risk of oesophageal cancer include being: Male; Obese; A smoker; Living with symptoms of GORD for more than 10 years; Experiencing three or more bouts of heartburn and related symptoms per week.
Diagnosis
Generally a doctor can diagnose GORD from the symptoms the patient describes. Further tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GORD. Tests will identify other possible causes of symptoms, such as bleeding from an ulcer, any abnormal growths and for cancer of the oesophagus.
Endoscopy
An endoscope is a thin, flexible, fibre-optic tube with a video camera at one end commonly used to help identify the causes of abdominal pain, nausea and vomiting, heartburn, bleeding and swallowing disorders and to help diagnose gastrointestinal conditions. With oesophageal cases, this tool checks the surface of the oesophagus for damage by stomach acid. To maximise the effectiveness of the endoscopy, a period of fasting is required before the procedure can be performed.
Endoscopy is advised if the person is over 55, or with unexplained, persistent symptoms or have presented with any of the alarm features outlined below indicating an increased risk of ulcers or cancer.
Alarm features include: Unexplained loss of weight; Poor and / or painful swallow; Recurrent vomiting (perhaps containing blood); Blood in stools; Anaemia from gastrointestinal haemorrhage or upper abdominal mass; Any family history of colorectal cancer and Chronic NSAID use
Like most cancers, early diagnosis and action maximise the likelihood of successful treatment. A specific style of treatment for this type of cancer is Photodynamic Therapy (PDT). This procedure involves injecting the oesophagus with a type of photo sensitive medication, making it ultra-sensitive to light. Once done, a laser is then attached to an endoscope which burns any cancerous cells.
Oesophageal manometry
If the outcome of an endoscopy is inconclusive a further procedure called a manometry may be done. This test indicates how well the oesophagus moves food down to the stomach (Peristalsis). Manometry can confirm GORD diagnosis or, if not, then perhaps a less common oesophageal problem such as muscle spasms or achalasia (a rare swallowing problem)
24-hour pH monitoring
If the manometry test cannot find any problems with the oesophageal sphincter muscles, another test called the 24-hour pH monitoring can be used. It tests for acidity in the oesophageal area.
Barium swallow
If the patient is showing dysphagia (poor swallow), they may be referred for a Barium Swallow Test, to fully assess their swallowing ability and identifying difficulties such as blockages or muscle problems. To begin, the patient drinks a Barium solution. The progress of the barium, once in the system can then be tracked via X-Ray.
Treatments
Antacids
Antacids are medicines that neutralise the effects of stomach acid. A dose usually gives quick relief. Antacids are used 'as required' for mild or infrequent bouts of heartburn. Examples of antacids are Rennies® and Maalox®.
Antacids can cause many drug interactions generally by reducing absorption of other drugs. Antacids may alter the pH of the stomach contents or urine sufficiently to alter drug absorption or excretion. The interactions can be avoided by taking these other drugs one hour before or three hours after the antacid.
Antacids can reduce absorption of antibiotics such as and ciprofloxacin and tetracycline, antifungals such as fluconazole (Diflucan®), blood pressure medication such as propranolol and captopril, ranitidine and famotidine (used to reduce stomach acid) and iron supplements. Antacids can also increase the effect of Sodium Valproate (Epilim®) which is used to treat epilepsy. Antacids can also damage enteric coating which many medicines have in order to protect the stomach from irritation.
Alginates
Alginates are an alternative to antacids. They are generally in liquid form and impart an adhesive protective coating to both the oesophagus and the stomach. This lining is then an effective barrier against the harmful effects of stomach acid and reflux. Examples include Gaviscon® and Acidex® and they should be taken after food and at night.
To be continued….next week more on GORD treatment.
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