GERD physiotherapy RPG
Epidemiology The incidence of gastroesophageal reflux disease in the population of developed countries is high, ranging from 20 to 40%, in the age groups 45 to 64 years to increase the incidence among 64-74 years old. The natural history of disease requires continuous upsurge with alternative periods of rest. Definition Gastric reflux can be defined as “involuntary and unconscious passage of stomach contents in” esophagus stomach and abdominal muscles. “The gastric reflux disease, commonly abbreviated as GERD (English gastroesophageal reflux disease, gastric reflux), consists of a set of painful symptoms and / or generates upset reflux into the esophagus of the stomach contents. Gastroesophageal reflux finds a when occasional physiological phenomenon and asymptomatic, and if it causes problems.
Symptoms of reflux disease may be due to pathological changes with gastroscopy and especially abdominal ultrasound are documented, in such cases speak disease in the highlighted secondary reflux disease (esophagitis, gallstones, etc.).
If it is not compatible with reflux symptoms induced detectable organic lesions such as ulcers or as’esophagitis, we use the term NERD (non-erosive esophagitis reflux disease) precisely to distinguish GERD. This is characterized by the presence of symptoms of reflux, the absence of damage to the esophageal mucosa. This condition causes 60-70% of cases of gastroesophageal reflux disease (GERD). The NERD is not only a functional disorder because the impedance monitoring pH documented problem reflux for 24 hours.
Esophageal impedance / 24 hours (pH MII / 24) pH allows patients with suspected NERD subclassified into three categories: – Category 1: impedenzometrico track patients with abnormal pH mixed with a pathological reflux, acid, or. – Category 2: patients with esophageal hypersensitivity, ie without pathologic reflux, but with a positive correlation between symptoms and reflux documented impedance pH (acid, or mixed). So reflux as normal in these patients stimulate painful sensations. – Category 3: Patients with functional heartburn, have symptoms of reflux mark or a pathological reflux or a positive association between reflux symptoms and pH metry Impedenzo-. These patients fall under the classification of disorders often also have symptoms of dyspepsia and irritable bowel syndrome have, and mental disorders such as anxiety and / or depression.
Pathogenesis of gastric reflux disease
Esaofageo gastric reflux is the return of stomach contents into the “esophagus.
The passage in the gastric cavity is regulated by the lower esophageal sphincter, which allows the transit of food, opens. Then, it is closed to prevent the rise to “esophagus of everything that exists in the stomach.
If the sphincter is released at inappropriate times and allows the passage of gastric contents up, he got the symptoms of reflux, for the material to irritate the esophageal mucosa. Under normal conditions, the stomach contents flow into the esophagus in small quantities and episodically. The pH impedance spectrometry documents 24 such pathological abnormality reflux.
The causes of gastroesophageal reflux disease
One of the main causes of the decrease in lower esophageal sphincter tone (SEI in Italian, English esophageal LES lower Sphinctere) is, that is the valve that separates the “esophagus from the stomach. Hypotension sphincter is an innate attitude the patient, but can through certain be nutrients promoted and consolidated and certain types of drugs. the prolonged persistence of food in the stomachfacilitates phenomenon reflux. they are predisposed hearty meals and the conditions that determine an increase in gastric pressure, as obesity, pregnancy and an unnecessary burden on the abdominal muscles. predisposes to a muscular stance of the membrane, which can be corrected with appropriate physiotherapy.
Smoking is a major risk factor, and because nicotine increases the secretion of stomach acid, and because it alters the composition of saliva, and functionality of the gastroesophageal sphincter.
Anxiety and stress are predisposed certainly factors. For the effect of muscle tension, and for actions in the central nervous system and its stations Hiatus hernia stomach is considered a muscular stance, often in combination with the dyskinesia inflammation-distal ‘esophagus induced and often it is associated with gastroesophageal reflux disease.
Factors involved in the opening and related relaxation of the lower esophageal sphincter (LES), in the pathogenesis of gastroesophageal reflux, lack of coordination between gastric peristalsis and the opening of the pylorus, with delayed gastric emptying, increased incidence of are to reduce stomach wall and the abdominal esophagus. transient LES relaxations are considered the main culprits. They last for 5 to 30 seconds and are intended to implement ‘airesophagus, in response to gastric distention under normal conditions.
This muscle relaxation mechanisms mediated vagal reflexes GERD can result in altered neurogenic control. Responsible for the severity of GERD are changes in the esophageal peristalsis (especially children show tendency to impaired esophageal motility and poor coordination of swallowing), changes in saliva that neutralizes the action of digestive juices in baking , which has rich and mucosal prostaglandins, are protective factors. Some medications (such as theophylline, beta-agonists, calcium channel blockers, narcotics, benzodiazepines, anticholinergics) and food (chocolate, fats, caffeine, licorice, carbonated beverages, alcohol, nicotine) contribute on the other side to that to determine GERD.