and sometimes have a longer course of illness
than viral gastroenteritis. Treatment for radiation
gastroenteritis focuses on dietary management
(eating frequent small meals and foods high in
fiber) with ANTIDIARRHEAL MEDICATIONSto help con-
trol diarrhea.
Risk Factors and Preventive MeasuresViral gastroenteritis is highly contagious and often
occurs in outbreaks, particularly in group settings
such as schools, day cares, nursing homes, camps,
and contained environments such as cruise ships.
These methods can significantly reduce infectious
gastroenteritis:
- proper food handling and preparation
- frequent and thorough HAND WASHING
- drinking WATER PURIFICATION(boiling, filtration,
chemical)
See also AMEBIASIS; COLITIS; CYCLOSPORIASIS; FOOD-
BORNE ILLNESSES; FOOD SAFETY; GASTRITIS; GIARDIASIS;
LISTERIOSIS; PARASITE; SALMONELLOSIS; SHIGELLOSIS;
WHIPPLE’S DISEASE.
gastroesophageal reflux disorder (GERD) A
chronic condition in which gastric contents leak
back from theSTOMACHinto the ESOPHAGUS. Because
stomach juices are highly acidic, this backwash cre-
ates chemical BURNSin the delicate tissues of the
esophagus. The lining of the esophagus lacks the
protective mucus that safeguards the stomach from
gastric acid, making it vulnerable to injury. Up to 40
percent of adults in the United States have GERD.
Though GERD can develop in people of any age,
including children, the likelihood of it doing so
increases with age. Treatments to manage GERD
include medical, surgical, and lifestyle methods.
Symptoms and Diagnostic PathThe symptoms of GERD often appear or are more
severe following meals, when lying on the back,
when bending over, and when lifting or straining.
Many people experience more severe symptoms at
night that awaken them from sleep. Typical GERD
symptoms are chronic (ongoing) and include
- PAIN, pressure, or burning sensation in the mid-
chest- NAUSEA, and less commonly VOMITING, after eat-
ing - regurgitation (reflux) of stomach contents up to
several hours after eating that causes a bitter
taste in the MOUTHand a burning sensation in
the THROAT
- NAUSEA, and less commonly VOMITING, after eat-
- a sense of fullness in the stomach even when
hungry
Some people also experience chronic sore
throat or hoarseness resulting from the persistent
reflux, or HICCUPS, likely due to irritation of the
DIAPHRAGM, where the esophagus and stomach
join, which is the site of the irritation. The diag-
nostic path may include BARIUM SWALLOW, gastroe-
sophagoscopy (endoscopic examination of the
esophagus and stomach), and breath or BLOOD
tests for the presence of HELICOBACTER PYLORI.
Because GERD is so common and the diagnostic
procedures are invasive, doctors often use a trial
of medication, such as H 2 ANTAGONIST(BLOCKER)
MEDICATIONSor PROTON PUMP INHIBITOR MEDICATIONS
(PPIs), to suppress gastric acid production and
then assume a diagnosis of GERD if the medica-
tion relieves the symptoms.Treatment and Outlook
Most people obtain full relief from their symptoms
with a combination of medical treatments and
lifestyle modifications. Many people find lifestyle
modifications (diet, WEIGHT LOSS AND WEIGHT MAN-
AGEMENT, SMOKING CESSATION) combined with
ANTACIDS adequate, while other people require
stronger medications such as H2 blockers or PPIs.
Many H2 blockers are available in over-the-
counter formulas. Reducing gastric acid signifi-
cantly reduces the amount reflux that can
backwash into the esophagus.
The most common surgical treatment for GERD
that fails to improve with medication and lifestyle
methods, fundoplication, reinforces the upper sec-
tion of the stomach (the fundus) to increase ten-
sion on the lower esophageal sphincter. There are
several fundoplication methods, some of which
the surgeon can perform laparoscopically and oth-
ers that require OPEN SURGERY. Another surgical
option is endoscopic gastroplasty to repair or
strengthen the lower esophageal sphincter. The50 The Gastrointestinal System