2.
Definition: Regurgitation is the sensation of acid
backing up into your throat or mouth without
nausea or forceful contractions of the abdominal
muscles
Regurgitation can produce a sour or bitter taste, and
you may experience "wet burps."
Regurgitation
3.
What is the difference between regurgitation and
vomiting?
While this difference is not often clinically relevant for
medical practitioners, it is used frequently for pets and
small children .
Difference on basis of passage:
Regurgitation is the returning of food that has not yet
reached the stomach to the mouth.
Vomiting is the forceful return of stomach contents,
including some amount of stomach acid to the mouth.
4.
Symptoms:
Effortless vomiting
No presence of nausea
Abdominal pain
Constipation
Bloating (distention/expansion due to interna pressure)
Sore esophagus and dental problems from acid erosion
GERD
Rumination syndrome
5. Pathomechanism: A ring-shaped muscle (sphincter) between the stomach and esophagus
normally helps prevent regurgitation.
Caues:
1. Regurgitation of sour-tasting or bitter-tasting material can result from acid coming up from the
stomach. (GERD)
2. Esophageal stricture: This is a condition in which stomach acids leak back up into the
esophagus and irritate the sensitive lining of the stomach, known as the mucosa. The irritation
can scar the esophagus, which then becomes narrow and constricted.
3. Regurgitation of tasteless fluid containing mucus or undigested food can result from a narrowing
(stricture) or a blockage of the esophagus or from an abnormal pouch in the esophagus called
a Zenker diverticulum.
4. The blockage may result from acid damage to the esophagus, ingestion of caustic
substances(strong acid & alkalies for suicide purposes they can burn tongue, mouth esophagus &
stomach)
5. cancer of the esophagus, (Barretts esophagus)- pre cancerous stage, occurs due to chronic
inflammation due to acid reflux and appears as abnormal cell lining in lower part of esophagus)
6. abnormal nerve control that interferes with coordination between the esophagus and its sphincter
at the opening to the stomach (achalasia), multiple sclerosis.
7.
Achalasia. When your lower esophageal muscle
(sphincter) doesn't relax properly due to degeneration of
nerves to let food enter your stomach, it may cause you to
bring food back up into your throat. Muscles in the wall
of your esophagus may be weak as well, a condition that
tends to worsen over time.
Cause of achalasia can be
1. Degeneration of nerves
2. Parasitic infection.
3. Cancer of esophagus
8. Zenker diverticulum: A Zenker’s diverticulum, more formally known as a
hypopharyngeal diverticulum, is a pouch that can form at the junction of the
hypopharynx (lower part of the throat) and the esophagus, an area known as
Killian’s Triangle. This pouch typically causes problems by trapping food as it is
being swallowed, leading to choking and aspiration.
CAUSE: A Zenker’s diverticulum typically arises due to tightness of the
cricopharyngeus muscle. This muscle makes up the upper esophageal sphincter, and
is located just below the level of the voice box. Normally, it relaxes during
swallowing to allow food to pass into the esophagus. When this muscle fails to relax,
the pressure of swallowing pushes the food against the posterior wall of the
hypopharynx, causing it to bulge slightly. The combination of obstruction, pressure
and bulging, repeated over thousands of swallows, eventually leads to a permanent
bulge or pouch — a Zenker’s diverticulum. The diverticulum continues to enlarge as
more and more food is pressed into it.
It is diagnosed radiographically with a study called a barium swallow.
The risk of developing a Zenker’s diverticulum increases as a person ages
If a Zenker’s diverticulum is causing symptoms, surgical treatment may be
recommended
9.
Pharynx: the membrane-lined cavity behind the nose
and mouth, connecting them to the oesophagus.
10.
11.
1- GERD:
Acid reflux occurs when some of the contents of the
stomach travel backwards into the oesophagus,
through the lower oesophageal sphincter (LOS) – a
circular band of smooth muscle – which can cause
pain and discomfort
It is caused by a loose sphincter at the opening that
connects the esophagus and stomach. Stomach
contents can move out of the stomach and into the
esophagus where they are partially regurgitated.
12.
13.
14.
3- ingestion of caustic substances:
Caustics (strong acids and alkalis), when ingested, burn
upper GI tract tissues, sometimes resulting in esophageal
or gastric perforation. Symptoms may include
drooling(secrete salive to anticipate food),
dysphagia, and
pain in the mouth, chest, or stomach; strictures may
develop later.
Diagnostic endoscopy may be required. Treatment is
supportive. Gastric emptying and activated charcoal are
contraindicated. Perforation is treated surgically.
15.
Acids cause coagulation(cause by lack of blood flow, it makes
structure dry, hard & white) necrosis(death of most or all cell in
the organ). Acids tend to affect the stomach more than the
esophagus.
Alkalis cause rapid liquefaction necrosis; and damage
continues until the alkali is neutralized or diluted. Alkalis tend
to affect the esophagus more than the stomach,
but ingestion of large quantities severely affects both.
Solid products tend to leave particles that stick to and burn
tissues, discouraging further ingestion and causing localized
damage. Because liquid preparations do not stick, larger
quantities are easily ingested, and damage may be widespread.
Liquids may also be aspirated, leading to upper airway injury.
16. Treatment of caustic substance ingestion:
Treatment of caustic ingestion is supportive. (Caution
Gastric emptying by emesis or lavage(wash) is contraindicated because it can re-expose
the upper GI tract to the caustic.
Attempts to neutralize a caustic acid by correcting pH with an alkaline substance [and
vice versa] are contraindicated because severe exothermic reactions may result.
Activated charcoal is contraindicated because it may infiltrate burned tissue and interfere
with endoscopic evaluation and
insertion of an NGT (nasogastric tube) this is access to stomachto drain gastric
contents is contraindicated because it can damage already compromised mucosal surfaces
Dilution with milk or water is only useful in the first few minutes after ingesting a
liquid caustic, but delayed dilution may be useful after ingesting a solid caustic.
Dilution should be avoided if patients have nausea, drooling, stridor, or abdominal
distention.
Esophageal or gastric perforation(separation at line) is treated with antibiotics and
surgery
17.
4- cancer of esophagus:
Adenocarcinoma is the most common form of esophageal
cancer. (occurs in mucus producing cells that line the
esophagus)
Squamous cell carcinoma. The squamous cells are flat, thin
cells that line the surface of the esophagus. Squamous cell
carcinoma occurs most often in the upper and middle portions
of the esophagus.
Barrett's esophagus (pre-cancerous form, accidentally caught
when some other test were performed) is a condition that can
be pre-cancerous or, in a more advanced state, an early form
of esophageal cancer. It is often the result of chronic
inflammation due to acid reflux, and appears as abnormal cells
lining the lower part of the esophagus.
18.
19.
5- Achalasia: is a rare disease of the muscle of the lower esophageal body
and the lower esophageal sphincter that prevents relaxation of the
sphincter and an absence of contractions, or peristalsis, of the esophagus.
The cause of achalasia is unknown; however, there is degeneration of the
esophageal muscles and, more importantly, the nerves that control the
muscles.
Common symptoms of achalasia include
difficulty in swallowing (dysphagia),
chest pain, and
regurgitation of food and liquids.
Treatment: s for achalasia include oral medications,
dilation or stretching of the esophagus,
surgery, and
injection of muscle-relaxing medicines (botulinum toxin) directly into the
esophagus.
20. 6- Multiple sclerosis: There are a variety of disorders and conditions that can lead to
regurgitation. Because of a lack of muscle control, multiple sclerosis is one
7-Rumination syndrome
Rumination syndrome is an uncommon condition where regurgitation occurs daily
and after every meal. Its cause is unknown. It's more likely in infants and those with
developmental disabilities.
Rumination syndrome is a disorder in which recently swallowed food is effortlessly
spit back up or regurgitated. This food is usually undigested and people with this
condition either spit it out or chew it and swallow it again. It is typical to experience
this regurgitation of food every day at multiple meals within 30 minutes of eating
The predominant symptom of rumination syndrome is regurgitation. Other
symptoms may include abdominal pain, constipation, weight loss, and coexisting
psychiatric conditions.
Cause: Muscle contractions in the abdomen must occur with enough force from
below to overcome the resistance (opposite force) of the sphincter and allow
swallowed food to move back up the esophagus.
21.
8- Indigestion, also called upset stomach,
9- Other Common causes are eating too much or too
rapidly; greasy or spicy foods; overdoing caffeine,
alcohol, or carbonated beverages; smoking; and
anxiety.
22.
9- Chronic gastritis:
Gastritis is an inflammation of the lining of the stomach.
"Chronic" means it is an ongoing condition that never
improves.
The stomach normally contains strong acids to break
down food. A layer of mucus lines the stomach to protect
it. If the mucus lining is not healthy, the stomach itself can
become inflamed.
A common cause of damage is the H. pylori bacteria. It
spreads through food, water, and shared eating utensils.
Other Common causes are eating too much or too rapidly;
greasy or spicy foods; overdoing caffeine, alcohol, or
carbonated beverages; smoking; and anxiety.
23.
Complications:
Regurgitation affects only the esophagus, stomach, and the
portion of the small intestine nearest the stomach
The stomach acid from the vomitus (vomiting) can affect cells
of the esophagus, causing metaplasia (change in cells), and
early changes that may cause cancer later in life.
It may also cause scarring of the esophagus and make it more
difficult to swallow.
The muscle contractions can cause stomach pain or upper
abdominal pain as well.
24.
Treatment at home:
Lose weight: Even if you're just a few pounds overweight,
losing anything excessive can reduce abdomen pressure and
prevent gastric juices from traveling upwards.
Adjust your diet: Avoid certain types of foods, including
anything fatty, spicy, or acidic. Coffee and carbonated
beverages should also be avoided.
Avoid alcohol: Water is best when it comes to fighting
regurgitation. Alcohol should be extremely limited or
completely avoided.
Wear loose clothing: Avoid wearing tight pants or belts. You
want the clothing around your stomach to be as loose as
possible
25.
Drink some herbal tea.
Opt for herbal teas to help calm your symptoms.
Firstly, if you drink lots of caffeine-rich tea and
coffee this could be problematic in itself, so making
some simple swaps would be recommended. But as
an added bonus, many tea varieties including
ginger(stimulant), peppermint and camomile are
very soothing and may help to offer some relief from
your symptoms.
Treat the disease which causes regurgitation
Regurgitation
