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Reflux GORD

Talks about the different sorts of reflux and the different types of treatment required to treat them.

Dr Xxxxx Dr Xxxxx : Reflux is a simple common condition generally single-mindedly managed by most doctors. It represents the reverse flow of fluids into the stomach and duodenum. Fluid and food masses in the duodenum may reflux into the stomach. Food and fluid matter in the stomach may reflux into the oesophagus. In some patients with severe oesophageal dysfunction, the food and fluid matter may reflux up into the mouth of the patient.

Reflux is often asymptomatic. That is only a percentage of people develop symptoms such as pain, discomfort, acid taste, or a feeling of food or fluids in the mouth or oesophagus.
As soon as most doctors hear this description, they conclude that acid reflux is present and that the patient will require treatment with an anti-acid medication. In the old days, treatment involves high dose anti-acids. Unfortunately, if antacids are swallowed, the stomach adapts by increasing acid secretion, worsening the problem. So, in the old days, the only way to prevent the bodies adaptation neutralising the treatment was simply to increase the anti-acid doses to very high levels.

Kinkajou Kinkajou: That all sounds pretty easy.
Dr Xxxxx Dr Xxxxx : The first new drugs to be developed to treat reflux were the H2 antagonist class of drugs. Old common drugs in this category included cimetidine and ranitidine. They used very rarely these days because they have a much more limited effect than your medication such as the PPIs (proton pump inhibitors). With H2 antagonist medications, patients on fairly high doses would still often get reflux symptoms and would still experience acid burn and acid burn complications.

With PPIs, (proton pump inhibitors) most patients could take a tablet or two on successive days and achieve rapid and often long-lasting relief of symptoms. About 10% of patients would require higher doses of these medications to achieve symptom control. The medicines were powerful enough to remove sufficient acid to even reverse precancerous changes due to chronic acid irritation.

Generally, for most people, a three-day burst of PPI treatment is enough to relieve symptoms of acid reflux and enough to allow the healing of acid burns. Often then the patients will not need treatment for several months, till again the acid reflux flares.

Kinkajou Kinkajou: So, PPIs are good effective medications to treat acid reflux.
Dr Xxxxx Dr Xxxxx : Unfortunately, the situation unbeknownst in most doctors is a lot more complicated than this. There are several different types of reflux.

Acid reflux is due to reflux of acidic fluid, (acid being produced the stomach lining to aid indigestion).

Bile acid reflux is due to reverse flow (reflux) of bile acids. These are secreted from the gallbladder into the duodenum, but then can flow back into higher levels of the duodenum and even into the stomach. Bile acids cause a different pattern of chemical irritation. Treating bile acid reflux with PPIs (proton pump inhibitors), does not work.

And there is another form of reflux as well. This is due to the reverse flow of enzymes secreted by the pancreas, (and to some extent the stomach lining), generally back into higher levels of the stomach. As you would expect, this form of reflux is also not sensitive to PPI (proton pump inhibitor) treatment.

Reflux GORD

Dr AXxxxxDr Axxxx : Also, Not everything that hurts is reflux. Gastritis is common. This represents inflammation of the stomach lining. Any of the refluxes can trigger this type of damage,  but illness and throat bacteria being swallowed (from a throat infection) will often cause the same symptoms as well.

And don’t forget sympathetic para-aortic ganglion-itis. This is one of the most common causes of upper abdominal pain and tenderness, and also a condition that most doctors will never diagnose in their life. A Paill Spectrum condition.

Dr Xxxxx Dr Xxxxx : So, the key message to take away is that there are a number of different sorts of reflux in the upper abdomen region. Each has a specific treatment. Acid treatment does not treat all of these types of reflux. Because acid reflux is by far the most common type of reflux, the PPIs used commonly - generally work commonly well. But there are a small number of people who need more careful consideration of the nature of the problems.

Erasmus Erasmus : And never forget that it is always possible that there could be a number of different problems in one part of the stomach. Some things are common, but doctors still need to be able to recognise the pattern. If it is a new pattern (such as sympathetic para-aortic ganglionitis)– it will never be recognised.