What is GERD?
GERD stands for gastroesophageal reflux disease.
It refers to the flow of the acidic juices of the stomach into the esophagus (the food passage that links the oral cavity to the stomach).
It happens because the junction between the gullet and the stomach does not function normally, resulting in reflux.
What are the symptoms?
- Heartburn (burning sensation of the chest that usually rises from the stomach to the throat)
- Acid regurgitation (bitter or sour taste in the mouth)
Symptoms possibly associated with reflux
- Burping or belching
- Chest pain or discomfort
- Tummy bloating
- Difficulty swallowing
- Hoarseness of voice
- Persistent sore throat
- Persistent cough
What problems could be related to reflux?
Most people with reflux do not get severe problems other than the symptoms of reflux.
Long standing reflux may potentially cause:
- Esophagitis- inflammation of the lower gullet
- Stricture-Severe long standing inflammation can cause narrowing of the gullet lumen.
- Barrett’s esophagus- changes to the cells of the lower esophagus, due to the damage done by the long standing acid reflux. Patients with Barrett’s esophagus have higher risk of esophageal cancer compared to the general population.
How is it diagnosed?
Reflux can be diagnosed by symptoms and the response to medication.
In some cases of GERD, inflammation of the gullet may be seen on endoscopy (a procedure when a flexible tube is placed via the mouth into the gullet and stomach)
Reflux can also be diagnosed with the help of 24-hour pH-monitoring – a tube is placed through the nose to the gullet and the acidity is measured.
When combined with Impedance testing (where a tube with multiple electrodes is inserted into the gullet), one can differentiate the contents of the reflux fluid, guiding the doctor in treatment.
Can lifestyle changes improve the symptoms?
Yes lifestyle changes can improve the symptoms, as described below:
You should try to avoid:
- Very spicy food
- Citrus fruits
You should also:
- Avoid eating too much for each meal
- Avoid eating within 2-3 hours before bedtime
- Avoid lying down after meals
- Eat regular meals
- Raise the head of the bed if there is night-time symptoms
- Citrus fruits
- Reduce weight if you are obese
How is it treated?
Antacids acts by neutralizing the acidic gastric juice.
Prokinetics refer to drugs that improves the stomach emptying.
Histamine-2-receptor antagonists reduces acid production.
Proton pump inhibitors (PPI) also decrease acid production, they are more effective than histamine-2-receptor antagonists.
Is there any role for surgery?
Most patients with reflux do not need surgery. However, if surgery is needed, a surgeon should be consulted to discuss the pros and cons of surgical treatment for reflux.
The indications for surgery in the patient with GERD include:
- Endoscopic and/or symptomatic failure of medical treatment of GERD
- History of contrast allergy.
- Recurrence despite medical therapy
- Volume regurgitation, dysphagia (difficulty swallowing)
- Atypical oesophageal and extra-esophageal symptoms
- Large hiatal hernia (>4 cm) (upper part of the stomach moves above the diaphragm)
- Barrett’s oesophagus
- Stricture formation (narrowing of the gullet lumen)
- Poor oesophageal peristalsis
- Prolonged reflux episodes (>5 min) on pH study
- Pathological bile testing