GASTROESOPHAGEAL REFLUX DISEASE (GERD)

1. WHAT IS GASTRO-ESOPHAGEAL REFLUX DISEASE?

Gastroesophageal Reflux Disease (GERD ) is also known as reflux esophagitis. This is a chronic disease that is common in Asian countries and tends to increase in Vietnam.

The causes of the disease are unhealthy diet, use of stimulants, alcohol, improper use of drugs, obesity... and the most prominent cause is stress and pressure at work and in life.

The disease occurs when gastric juice, bile or food in the stomach refluxes occasionally or frequently into the esophagus, thereby causing symptoms and complications of the disease.

2. WHAT ARE THE SYMPTOMS OF GASTROESOPHAGEAL REFLUX DISEASE?

Typical symptoms of GERD include heartburn, acid reflux, vomiting, nausea, presternal pain, feeling of choking after swallowing food, increased salivation, bad breath and bitter taste in the mouth. However, not all people with GERD have the typical symptoms above.

Although GERD is a disease entirely of the digestive tract, it is easy for patients to mistake:

- The patient thought he had heart disease when he felt chest pain, and cardiovascular specialist treatment did not help with normal echocardiogram and electrocardiogram results.

- Sometimes patients suspect lung disease when they have a persistent dry cough and a normal chest X-ray.

- Or see an ENT doctor when you have hoarseness, sore throat, etc.

3. I HAVE BEEN TO THE DOCTOR MANY TIMES AND THE DOCTOR SUSPECTS THAT I HAVE GASTRO-ESOPHAGEAL REFLUX DISEASE, AND HE RECOMMENDED AN ESOPHAGEAL-GASTRO-ENDOSCOPY, BUT I'M VERY AFRAID OF ENDOSCOPY. HOW CAN I KNOW IF I HAVE GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT HAVING AN ENDOSCOPY, DOCTOR?

Gastrointestinal endoscopy is the only way to evaluate esophageal-gastric damage. In addition, endoscopy can also detect whether you are infected with Helicobacter Pylori (HP) bacteria or not?

If you are afraid of the feeling of endoscopy, we can approach a new technique called painless esophagogastroduodenoscopy. This is a procedure that eliminates the feeling of pain and discomfort during endoscopy. You will sleep during the endoscopy for a few minutes, and you will wake up immediately after the endoscopy. The short pre-anesthesia time is not harmful to your health and you no longer feel pain, discomfort and fear during endoscopy.

4. COMPLICATIONS OF GASTROESOPHAGEAL REFLUX DISEASE?

If left untreated, GERD can lead to complications in the esophagus such as:

- Inflammation, ulcers, bleeding, narrowing of the esophagus causing difficulty swallowing.

- Barrett's esophagus is a condition in which the normal esophageal tissue structure changes, leading to an increased risk of esophageal cancer.

- At the same time, GERD can cause extra-esophageal diseases such as laryngitis, sinusitis, rhinopharyngitis,...

- To avoid the dangerous complications mentioned above, as soon as the first symptoms of gastric reflux appear, the patient needs to follow up and receive early treatment with a gastroenterologist.

5. IN ADDITION TO ESOPHAGEAL DISEASES CAUSED BY REFLUX, WE ALSO OFTEN ENCOUNTER ESOPHAGEAL ULCERS DUE TO IMPROPER USE OF MEDICATIONS. DOCTOR, WHICH MEDICINES CAN CAUSE ESOPHAGEAL ULCERS?

There are many types of drugs that, when used incorrectly, can cause esophageal ulcers, such as the antibiotic Doxycycline (commonly used to treat acne and gynecological infections), anti-inflammatory pain relievers, Biphosphonate osteoporosis medications... even the pain reliever and fever reducer Paracetamol has been reported in Asian medical literature to cause esophageal ulcers.

6. WHAT SHOULD WE DO TO PREVENT ESOPHAGEAL ULCERS DUE TO MEDICATION?

Rest assured that most cases of drug-induced esophageal ulcers can be cured and rarely cause serious complications.

Taking medication correctly is an important factor but is rarely mentioned and given due attention. Patients are often advised on how to use medication during the day, on dosage, before or after meals... but patients have very little information on how to take medication to avoid affecting the esophagus.

Patients who take medication but drink little water, even swallow the whole pill without water, take medication in a lying position or lie down immediately after taking medication, so the medication may not reach the stomach and remain in the esophagus.

Especially for pills prepared in capsule form, the drug shell will soften very quickly when exposed to a humid environment and easily stick to the esophagus wall when drinking little water.

Too high a local drug concentration will cause direct toxicity to the esophageal wall, or some drugs when disintegrating will create alkaline or acidic substances that burn the esophageal wall and can create large ulcers or multiple ulcers.

Esophageal ulcers caused by drugs are common in the elderly because the contractile function of the esophagus to push drugs down to the stomach is often weaker than in young people, and because the elderly often have the habit of lying down to take drugs or lying down to rest immediately after taking drugs.

THEREFORE:

- The medicine should be taken in a standing or sitting position and with at least 250ml of water.

- After taking the medicine, you should walk, stand or sit for at least 30 minutes. Avoid taking the medicine right before going to bed.

- For the elderly and people with chronic illnesses who have to stay in one place: the head of the bed should be raised or the patient should be helped to sit up when taking medicine. This is also beneficial in helping to avoid the risk of aspiration into the airways, which can lead to respiratory failure or aspiration pneumonia for the patient.

- In addition, priority should be given to choosing pharmaceuticals formulated in emulsion form for these subjects.

7. HOW TO TREAT GASTRO-ESOPHAGEAL REFLUX DISEASE?

a) Non-drug treatment (lifestyle changes):

- Change your diet: limit foods high in fat, fried foods, spices (onions and garlic), acidic fruits, chocolate, mints, carbonated drinks, cola, strong coffee. Avoid eating a lot, avoid late meals and do not eat at night. Do not use milk and dairy products before going to bed. Avoid lying on your back, avoid wearing tight clothes right after eating.

- Don't stay up late and work hard.

- Establishing a healthy, reasonable diet and lifestyle, a scientific work regimen, limiting nervous tension and exercising helps prevent and limit the recurrence of gastroesophageal reflux disease.

- Limit alcohol and tobacco.

- Lie down with a high pillow and avoid bending forward.

- Take medication properly and as prescribed by your doctor .

- You should lose weight if you are obese.

b) Drug treatment:

Inhibition of gastric acid secretion: is the first-line treatment, used daily, continuously. Treatment time is usually longer than for common gastric ulcers and treatment is under the guidance of a Gastroenterologist.

Drugs that regulate peristalsis, drugs that increase lower esophageal sphincter pressure and clean the esophagus, drugs that reduce stress and anxiety: can be combined depending on each patient.

8. DOCTOR, I HAVE SUFFERED FROM GASTROESOPHAGEAL REFLUX FOR A LONG TIME, I HAVE TREATED MANY PLACES AND USED MANY MEDICINES, I HAVE FOLLOWED WHAT ANYONE RECOMMENDED BUT IT STILL HAS NO EFFECT. I HAVE LOOKED UP INFORMATION ON THE INTERNET AND THE MEDICINES I AM USING ARE THE BEST MEDICINES TODAY. RECENTLY I HAVE FELT DEPRESSED AND UNABLE TO CURE MY ILLNESS, I FEEL REALLY STRESSED. CAN MY DISEASE BE CURED, DOCTOR?

In the hustle and bustle of modern society and its many challenges, we have too many things to worry about, such as work outside of society, family work, children's education, increasing living expenses, etc., so stress is inevitable. If stress occurs frequently, it will cause many serious diseases such as high blood pressure, myocardial ischemia, etc. and especially cause gastroesophageal reflux disease.

Therefore, in treating the disease, in addition to taking medicine, reducing stress and avoiding tension is an extremely important and indispensable issue in the treatment regimen.

Anxiety, tension, stress due to work pressure, family greatly affects current life, you often feel uncomfortable, insecure, angry and irritable, making us lose interest in work, daily life. Prolonged anxiety and depression can cause severe psychological trauma, not only affecting you but also negatively affecting family life and those you love.

So what should we do when faced with these problems? Listening and support from a psychological consultant can help you reduce stress in life, help you increase your inner strength and potential, and help you balance your life as soon as possible.

Psychotherapy is the best way to help you relieve stress, overcome shock, emotions and anxiety to help you better understand your problems, address your ability to control, and adjust the balance in your life.