Gastro-esophageal reflux disease (GERD) is a disease that affects the gastrointestinal tract. Around 40% of Rett syndrome patients have GERD, particularly those with restricted mobility and scoliosis. Pain, anxiety, and excitement can exacerbate GERD and increase discomfort.
What causes GERD?
GERD occurs when the muscle situated at the lower end of the esophagus — the tube connecting the mouth and stomach — does not close properly after food has passed into the stomach. This allows food and acid from the stomach to pass up the esophagus. Acid from the stomach may also flow back into the esophagus (called acid reflux) because of delayed gastric emptying. GERD can be painful, and in extreme cases can damage the lining of the esophagus.
Symptoms and diagnosis
Many different symptoms might indicate GERD, including:
- weight loss despite a good appetite
- sour breath, burps, or belching
- regular vomiting
- refusing food or repeated chewing with a reluctance to swallow (rumination)
- coughing after feeding
- iron deficiency or anemia
- poor respiratory health
- behavioral problems, such as irritability, during or immediately after eating
- dental erosion
In addition to these symptoms, tests may be needed to confirm a diagnosis of GERD. These include:
Management of GERD
GERD can be managed to a certain extent through diet and lifestyle changes. Some medications available can also treat its symptoms. In more severe cases, surgery may be required.
Diet and lifestyle changes
- Foods that trigger reflux such as citrus fruits, caffeinated drinks, and carbonated drinks should be eliminated from the diet.
- More frequent and smaller meals increase the speed of digestion and may prevent acid reflux.
- Thickening food, in consultation with a doctor or dietician, can sometimes be effective.
- Posture while eating is very important in managing GERD. An upright position ensures that the digestive organs are not cramped, and gravity helps the correct movement of food, fluids, and digestive juices. If the patient needs to be fed lying down, then the head should be elevated. If able, the person should stay upright for a few hours after a meal.
- Wear loose-fitting clothing around the stomach, to ease pressure that might trigger reflux.
- Stress can exacerbate GERD. A stress-free and positive eating experience can be helpful in managing GERD.
- Proton pump inhibitors (PPIs) such as lansoprazole, omeprazole, and pantoprazole, decrease stomach acid and can alleviate the symptoms of GERD.
- H2-blockers, also called H2-receptor antagonists, can also be used to diminish stomach acid.
- Prokinetics, such as domperidone, bethanechol, and metoclopramide, work by strengthening the lower esophageal sphincter muscle that is situated between the esophagus and the stomach. They prevent food and stomach acid from rising back into the esophagus.
In severe cases, a fundoplication surgery may be performed, wherein the upper part of the stomach is wrapped around the lower end of the esophagus and stitched into place to prevent the backflow of stomach contents.
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