UNDERSTANDING GASTROESOPHAGEAL REFLUX DISEASE (GERD)

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What is Gastroesophageal reflux?

Gastroesophageal reflux occurs when the esophageal sphincter does not close correctly, causing the contents of the stomach to leak back into the food pipe. When stomach acid enters the esophagus it causes inflammation and burning sensations which are known as acid reflux. When the condition becomes chronic and serious, it is called Gastroesophageal Reflux Disease GERD.

GERD can occur in people of all ages and is usually the result of overeating, eating specific foods or lying down immediately after eating. It is most common among people who:
Are overweight or obese which causes increased pressure on the abdomen.
Are pregnant which also causes increased pressure on the abdomen.
Are taking some types of medication, including medicines for asthma, calcium channel blockers, antihistamines, sedatives, and antidepressants.
Are smokers or those who are exposed to second hand smoke.
Consume alcoholic drinks.
Do not get enough exercise.

- In addition, certain foods and eating habits have been linked to the occurrence of acid reflux. These include:

There are a number of actions and precautions that may be taken to reduce the chances of GERD occurring:
Eating moderate amounts of food and especially not overeating.
Not sleeping for 2 or 3 hours after eating.
Stop smoking.
Not wearing clothes that are tight or constrict the abdomen.
Sleeping at a slight angle with the head elevated a little.

The most common symptom of GERD is heartburn. Other signs of the condition include:
Dry, persistent coughing .
Wheezing
Stop smoking.
Asthma and Recurrent pneumonia
Nausea
Vomiting
Throat problems, such as soreness, hoarseness, or laryngitis (voice box inflammation)
Difficulty or pain when swallowing
Chest or upper abdominal pain
Dental erosion
Bad breath

If not treated, GERD can become worse and turn into other medical conditions which include:
Esophagitis: This is an inflammation of the esophagus.
Esophageal stricture: In this condition, the esophagus becomes narrow, making it difficult to swallow.
Barrett’s esophagus: The cells lining the esophagus can change into cells similar to the lining of the intestine. This can develop into cancer.
Respiratory problems: It is possible to breathe stomach acid into the lungs, which can cause a range of problems including chest congestion, hoarseness, asthma, laryngitis, and pneumonia.

There are a number of tests, often used in combination, to confirm the presence of GERD. These include:
Endoscopy
Barium X-ray: Imaging the esophagus, stomach, and upper duodenum after swallowing a chalky liquid that helps provide contrast on images
Esophageal manometry: Pressure measurement of the esophagus
Impedance monitoring: Measuring rate of fluid movement along the esophagus
pH monitoring: Acidity testing

GERD is typically treated with medication. Proton pump inhibitors, which decrease the amount of acid produced in the stomach, are one of the main pharmaceutical treatment options available. Lifestyle modifications can also help in dealing with the condition. These include:
Posture improvement such a sitting correctly
Wearing loose, unconstricting clothing.
Losing excess weight is overweight or obese.
Avoiding wearing tight belts or doing physical activities that increase pressure on the abdomen.
Stopping smoking.
If the condition does not respond to medication and lifestyle changes, then surgical intervention, known as fundoplication may be required.

Article by Dr. Kannan. D,
M.S, M.CH(GASTRO), FRCS(GLASG)
Surgical Gastroenterologist, Kauvery Hospital