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Doctor Department of Medical Examination & Internal Medicine - Vinmec Hai Phong International General Hospital
Gastroesophageal reflux refers to the reflux of gastric juice into the esophagus. Most patients with GERD have only mild, occasional symptoms that do not usually go to the doctor, possibly physiological.
1. Is gastroesophageal reflux disease easy to diagnose?
Gastroesophageal reflux disease (GERD) is the most accurate diagnosis by measuring intraesophageal pH, but this is a relatively difficult survey to perform and is currently not common in Vietnam. The diagnosis of gastroesophageal reflux disease (GERD) can often be based on clinical symptoms alone in patients with classic symptoms such as heartburn and/or vomiting. Although 40 to 90% of patients with symptoms suggestive of GERD have a symptomatic response to proton pump inhibitors (PPIs), response to antisecretory therapy is not a diagnostic criterion for GERD. Patients without classic symptoms - Other symptoms (eg, chest pain, burning sensation, chronic cough, hoarseness, wheezing, and nausea) may be present in the GERD setting, but are not sufficient to make a clinical diagnosis of GERD in the absence of the classic symptoms of heartburn and vomiting. Other disorders should be ruled out before attributing symptoms to GERD. For example, unexplained chest pain should be evaluated with an electrocardiogram and a stress test prior to gastrointestinal evaluation.
The differential diagnosis of gastroesophageal reflux disease (GERD) includes:
Infective esophagitis Drug esophagitis Eosinophilic esophagitis Other causes of dysphagia include muscular dysphagia. esophageal ring and impaired motility due to esophageal motility disorders.
2. Why does gastroesophageal reflux take a long time to heal and quickly recur?
2.1 Long-term gastric reflux
Gastroesophageal reflux has many causes of which lifestyle is a common cause and difficult to change. Due to improper use of the drug. Approximately 10 and 40 percent of patients with symptomatic gastroesophageal reflux disease (GERD) do not respond completely or only partially to proton pump inhibitors (PPIs).
Duration and adherence to medication - Poor timing and adherence to proton pump inhibitors (PPIs) are an important cause of inadequate acid suppression and refractory GERD. PPIs should be administered 30 to 60 minutes before breakfast for maximal proton pump inhibition.
In a study that included 100 patients with GERD, only 46% of patients prescribed PPIs for GERD were taking it as advised. Using PPIs before meals provides better control of pH in the stomach than when taken during or after meals.
Differences in PPI metabolism - PPIs are metabolised via the hepatic cytochrome system, with CYP2C19 playing a dominant role. CYP2C19 activity is determined to some extent by genetic polymorphisms.
Approximately 5 percent of Caucasian patients and > 10 percent of Asians, are homozygous for the CYP2C19 (i.e. slow metabolizer) mutation, potentially leading to greater gastric acid suppression. However, in wild-type homozygotes (rapid metabolizers), the effect of PPIs on gastric acidity is diminished and may contribute to PPI failure.
Adhering to the time of taking the drug: The time of using the drug is usually 4-8 weeks. Sometimes 7-10 days of treatment, but the recurrence is very fast. Therefore, it should be noted that drugs such as PPIs, if used and stopped suddenly, can cause an increase in acid secretion and cause the disease to return quickly.
2.2 Gastric reflux is easy to recur
Patients are subjective when they have the disease in the early stages and do not go for treatment right away:
Eating and living in moderation Eating spicy foods, foods that are too hot or too cold Eat too late, eat at night Eating wrong meals, or Skipping meals Vigorous exercise or lying down right after eating Often staying up late Smoking, drinking alcohol, beer, coffee Frequent anxiety, nervous stress Obesity is also a cause Secretory drugs do not work For a long time, when stopping the drug, reflux is easy to come back. Effect of weather: Cold weather is also a factor that is prone to reflux
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