- What is GERD?GERD or gastro-esophageal reflux disease is a term used to describe the symptoms or damage to the lining of the food pipe (esophagus) caused by reflux of stomach contents into the esophagus.
- How common is this?This is one of the commonest health problems especially in the developed world. Various studies estimate about 10-20% of the Western population to have symptomatic GERD, but the prevalence is fortunately less amongst Asians.
- What are the symptoms of GERD?Typical Symptoms: This includes heartburn (discomfort or burning sensation behind the breastbone) and regurgitation of stomach contents into the back of the throat.
Atypical Symptoms: This includes chest pain, upper abdominal pain, abdominal bloating and frequent burping.
GERD may be associated with a change in voice, sinusitis, pharyngitis, tonsillitis, frequent throat clearing, chronic cough, poor oral hygiene, dental decay, worsening of asthma and a sensation of something stuck in the throat.
- Who is at risk of developing GERD?The risk factors for developing GERD include:
Lifestyle: Smoking, alcohol, coffee and over-weight.
Age: Though the elderly and those with a family history of GERD are at risk, we see a lot of younger age patients with significant GERD symptoms.
Medical: Pregnancy, hiatus hernia, food pipe motility problems, some medications and patients with medical and psychological problems.
The special muscle at the lower end of the food pipe called the lower esophageal sphincter (LES) and the structures surrounding this area help prevent the reflux of stomach contents into the food pipe. The above-mentioned risk factors alter this protective mechanism, thereby leading to GERD.
- What are the complications of GERD?GERD may lead to ulcer and narrowing of the food pipe, change in the lining of the food pipe called Barrett’s esophagus which may lead to cancer. As mentioned earlier, GERD can lead on to various other problems involving the lungs (asthma), throat, teeth, etc.
- How do we diagnose GERD?Endoscopy: An upper GI endoscopy wherein a flexible tube is passed down the throat to assess the lining of the food pipe and stomach is usually the first-line test for GERD.
pH Studies: Assessing the pH of the lower part of the food pipe over a period of 24 hours is considered the gold standard test to diagnose GERD.
Manometry: High-resolution manometry helps to assess the food pipe’s motility and the lower esophageal sphincter.
- What is the treatment for GERD?Lifestyle Modification: Weight loss, avoid precipitating factors like smoking, alcohol and spicy food, not going to bed with a full stomach and raising the head end of the bed.
Medical Treatment: Though H2 receptor antagonists like Ranitidine and prokinetic drugs like Cisapride have been extensively used in the past, proton-pump inhibitors (Pantoprazole, Omeprazole, etc.) are much more effective in the treatment for GERD along with antacid medicines.
Surgical Treatment: Antireflux surgery (fundoplication) creates a mechanical antireflux barrier between the esophagus and stomach.
Take Home Message: Please consult a gastroenterologist at an earlier stage if you have symptoms suggestive of GERD for a prompt diagnosis and effective treatment.
Dr. Muralidharan Parthasarathy
Consultant – General, GI, Laparoscopic & Bariatric Surgeon
Kauvery Hospital, Chennai