Regurgitation

Regurgitation (lat. Regurgitatio) is the emergence of involuntary return of gastric contents into the esophagus and throat. Regurgitation occurs without sickness, stress or spasms of the abdominal muscles or the urge to vomit (the difference in relation to the act of vomiting). Regurgitation usually occurs after a meal, and worsens with folding in a supine position. It is particularly unpleasant in form of acid regurgitation at night, while people are sleep. Then the patient suddenly awakens from sleep due to strong irritation of the throat and urging to cough, and have a feeling that they will “drown”. Regurgitation can easily cause respiratory complications if the regurgitated content is inhaled.

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Regurgitation is usually present in patients who have a larger hiatal hernias, when the defense mechanism of the lower esophageal sphincter (LES) is fully destroyed or in cases of distal obstruction (obstacles to the esophagus), which are usually associated with achalasia or large diverticula of the distal the esophagus. Returned content usually consists of a slimy colorless liquid or undigested food.

Regurgitation in varying degrees of intensity occurs in approximately 80% of patients with GERD.  Approximately 13% of patients with GERD feels regurgitation at least 4 days a week, which in itself is a frequency that substantially reduces quality of life. Regurgitation is a specific symptom of gastroesophageal reflux disease, and if it is associated with heartburn, a diagnosis of GERD can be placed safely in about 70% of cases. Regurgitation is in about 25% of patients associated with some degree of delayed gastric emptying (gastroparesis), and in these patients the incidence of complications of GERD increased. As a symptom of regurgitation has basically anatomical disorder, the use of drug therapy has considerably less success in eliminating the symptoms, than it is the case when there is a isolated heartburn.

Regurgitated acid content in the pharynx and mouth leads to stimulation of the salivary glands and the consequent hypersalivation, and urges ingestion of large amounts of saliva in order to minimize unpleasant sour taste (water brush). Excessive swallowing of saliva leads to the ingestion of large amount of air, which in a certain way creates a vicious circle and worsens existing regurgitation.

There are two clinical conditions in which regurgitation is not the result of GERD, but can easily be confused with it. One is in patients with achalasia, when retained food and fluid in the esophagus, not the stomach, return back into the pharynx. In achalasia patients, the regurgitated content has no gastric acid or bile and it consists mainly of previously entered undigested ingredients and occasionally greater amount of saliva. Other clinical condition that can mimic GERD is caused by regurgitation rumination. Rumination occurs during meals and represents an acquired behavior in which an individual unconsciously causes the return of gastric contents back into the esophagus through the mouth and then swallowing it again.

The main significance of the symptoms of regurgitation represents its impact on a significant reduction in the quality of life in patients with GERD, and is generally not associated with success while treating the symptoms of heartburn by using acid-suppressive therapy.

About the causes of regurgitation read more under hiatal hernia.

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