Gastroesophageal Reflux Disease (GERD)

Symptoms: Nausea, persistent vomiting, heartburn, regurgitation, dysphagia
Risk Factors: Frequent acid reflux, lower esophageal sphincter abnormalities, 
Prevalence: Currently, 15-25% of the population worldwide have GERD. In India, the total number of individuals suffering from IBD is approximately 7.6-30%. 
Severity: Mild- Severe.
Gender affected: Both male and female populations can be affected by GERD.
Which doctor to consult: A general physician, gastroenterologist.

Overview: 

Gastroesophageal Reflux Disease (GERD) is a chronic digestive condition where stomach acid frequently flows back into the oesophagus (a tube-like structure from where the food passes to the stomach), causing irritation and discomfort. 

Common symptoms of GERD include a burning sensation in your chest (heartburn), usually after eating, upper abdominal or chest pain, difficulty swallowing (dysphagia), chronic cough. The main cause of GERD is frequent acid reflux—the backwash of stomach acid into the oesophagus. This can happen if the lower oesophagal sphincter (LES) doesn’t close properly or opens too often, allowing acid to escape from the stomach into the oesophagus.

If left untreated, GERD can lead to more serious health issues like esophagitis (inflammation of the oesophagus), difficulty swallowing, etc. Treatment of GERD include lifestyle changes and over-the-counter medications. However, some may require prescription medications or surgery to alleviate symptoms and prevent complications

Remember, if you experience severe or frequent symptoms, it’s important to seek medical attention.

Types of Gastroesophageal reflux disease:

Gastroesophageal Reflux Disease (GERD) can be classified into different types based on the severity and the damage caused to the esophagus. Here are the types of GERD:

• Stage 1 or Mild Acid Reflux: Occurs when symptoms are infrequent and mild in nature.

• Stage 2 or Moderate Acid Reflux: Symptoms occur more frequently, multiple times a week, and may require daily medication.

• Stage 3 or Severe Acid Reflux: This involves more intense and frequent symptoms that significantly affect quality of life

• Recurrent but Nonprogressive GERD: Symptoms recur but do not worsen over time.

• Stage 4 or Progressive GERD: Symptoms worsen over time and may lead to complications like strictures or Barrett’s esophagus.

It’s important to consult a healthcare provider for an accurate diagnosis and appropriate treatment if you suspect you have GERD or are experiencing symptoms.

Symptoms

Gastroesophageal reflux disease (GERD) is a chronic digestive condition where stomach acid flows back into the oesophagus, causing various symptoms. Here are the common symptoms of GERD:

• Heartburn: A burning sensation in the chest, often after eating, which might worsen at night.

• Regurgitation: A backwash of food or sour liquid from the stomach into the mouth.

• Dysphagia: Difficulty swallowing.

• Cough: Persistent dry cough that may worsen.

• Hoarseness or sore throat: Often a result of irritation from stomach acid.

• Sensation of a lump in the throat: Feeling as if something is stuck.

• Odynophagia (pain while swallowing)

• Belching (expelling excess air from your upper digestive tract)

• Epigastric pain (upper abdominal pain)

• Nausea

• Persistent vomiting

If you’re experiencing severe, new, or persistent symptoms, it’s important to consult a healthcare provider. Remember, these symptoms can also be indicative of other conditions, so professional medical advice is crucial for a correct diagnosis and appropriate treatment.

Causes and Risk factors:

Gastroesophageal reflux disease (GERD) occurs when the lower oesophagal sphincter (LES), the muscle ring that closes the bottom of the oesophagus, does not function properly. This malfunction allows stomach acid to flow back into the oesophagus, causing irritation. Here are some of the causes and risk factors associated with GERD:

• Frequent Acid Reflux: The backflow of stomach acid or bile into the oesophagus is the primary cause of GERD.

• Lower Esophageal Sphincter Abnormalities: If the LES is weak or relaxes inappropriately, it can lead to GERD.

• Hiatal Hernia: A condition where part of the stomach pushes up through the diaphragm, which can impair the function of the lower oesophagal sphincter (LES). 

• Pregnancy: Hormonal changes and the physical pressure of the growing fetus can contribute to GERD during pregnancy.

• Connective Tissue Disorders: Conditions like scleroderma can affect the LES and other parts of the digestive tract.

• Delayed Stomach Emptying: Conditions that slow the gastric emptying, like gastroparesis, can increase the risk of GERD.

• Smoking: It can relax the LES and stimulate acid production, increasing the risk of acid reflux.

• Diet: Consuming large meals, eating close to bedtime, or eating certain foods (like fatty or fried foods) can trigger reflux.

• Alcohol Consumption: Drinking alcohol can relax the LES and increase stomach acid.

• Medications: Some medications, including aspirin, can cause or worsen GERD symptoms.

Managing these risk factors through lifestyle changes and medications can help alleviate the symptoms of GERD. If you suspect you have GERD, it’s important to consult a healthcare provider for a proper diagnosis and treatment plan.

Complications:

Gastroesophageal reflux disease (GERD) can lead to several complications if not managed properly. Here are some of the potential complications associated with GERD:

• Esophagitis: This is the inflammation of the oesophagus caused by the stomach acid breaking down the tissue lining, which can lead to bleeding and ulcers.

• Esophageal Stricture: Chronic acid reflux can cause formation of scar tissue in the oesophagus, which can narrow the oesophagus and make swallowing difficult.

• Barrett’s Esophagus: In this condition, the normal tissue lining the oesophagus changes to tissue that resembles the lining of the intestine. This can increase the risk of developing oesophagal cancer.

• Esophageal Ulcer: This is an open sore in the oesophagus, which can bleed and cause pain.

• Esophageal Adenocarcinoma: Long-term GERD can increase the risk of this type of oesophagal cancer.

• Aspiration Pneumonia: Stomach acid can be aspirated into the lungs, causing pneumonia or worsening asthma symptoms.

It’s important to manage GERD symptoms through lifestyle changes, medications, or surgery if necessary, to prevent these complications. If you’re experiencing severe or frequent symptoms, it’s advisable to consult a healthcare professional for proper diagnosis and treatment

Prevention:

Preventing gastroesophageal reflux disease (GERD) involves lifestyle changes and dietary adjustments. Here are some tips to help prevent GERD:

• Maintain a Healthy Weight: Excess weight can put pressure on your abdomen, pushing up your stomach and causing acid to reflux into your esophagus.

• Eat Smaller Meals: Large meals can increase stomach pressure, leading to reflux. Eating smaller, more frequent meals can help.

• Avoid Trigger Foods: Foods and drinks such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine can trigger reflux.

• Don’t Lie Down After Eating: Wait at least three hours after eating before lying down or going to bed.

• Elevate the Head of Your Bed: If you experience heartburn at night, raise the head of your bed six to nine inches to help gravity keep gastric acid down in your stomach.

• Quit Smoking: Smoking decreases the lower esophageal sphincter’s ability to function properly.

• Wear Loose-Fitting Clothes: Tight clothes can squeeze your stomach area and push acid up into your esophagus.

• Stay Upright: For at least three hours after meals, avoid reclining and slouching; this allows gravity to work in your favor and keeps stomach acid down.

• Avoid Late Meals: Try to avoid eating close to bedtime; having your big meal at lunchtime is better.

Implementing these strategies can significantly reduce the risk of GERD symptoms. However, if you’re experiencing frequent or severe symptoms, it’s important to consult a healthcare professional for personalized advice and treatment options

When to visit a doctor:

You can visit a general physician or a gastroenterologist if you have any symptoms such as difficulty sleeping due to acid reflex, nausea, sudden weight loss, wheezing, heartburn, vomiting, etc. Based on your physical examination and the signs and symptoms, your doctor will advise diagnosis.

Diagnosis:

The diagnosis of Gastroesophageal Reflux Disease (GERD) typically involves a combination of medical history review, physical examination, and diagnostic tests. Here’s a summary of the diagnostic process:

Medical History and Physical Examination:

• A healthcare provider will start with a thorough review of the patient’s symptoms and medical history.

• A physical examination may provide additional clues about the presence of GERD.

Diagnostic Tests:

• Upper Endoscopy: A procedure where a thin, flexible tube with a camera is inserted down the throat to examine the esophagus and stomach for signs of damage or inflammation.
• X-ray of the Upper Digestive System: After drinking a chalky liquid that coats the digestive tract, X-rays are taken to visualize the esophagus and stomach.
• Esophageal pH Monitoring: A device is placed in the esophagus to monitor the amount of acid that flows into it from the stomach.
• Esophageal Manometry: This test measures the rhythmic muscle contractions in the esophagus when swallowing.
• Barium Swallow (Esophagogram): A barium contrast is used to visualize the esophagus during an X-ray.
• Acid Perfusion Test (Bernstein Test): To determine if chest pain is caused by acid reflux.

These tests help in confirming the diagnosis of GERD and in assessing the severity of the condition. It’s important to consult with a healthcare provider to determine the most appropriate diagnostic approach for your specific situation. Remember, only a medical professional can provide a diagnosis and recommend an appropriate treatment plan.

Treatment:

The treatment for GERD typically includes a combination of lifestyle changes, medications, and in some cases, surgery.

Medications:

• Antacids: Over-the-counter antacids can provide quick relief by neutralizing stomach acid.
• H-2 receptor blockers: These medications reduce acid production and can provide longer relief than antacids.
• Proton pump inhibitors (PPIs): These are stronger acid blockers than H-2 receptor blockers and are available over-the-counter or by prescription.
• Prokinetics: These help your stomach empty more quickly.

Lifestyle Changes:

• Lose weight if you’re overweight.
• Eat smaller, more frequent meals rather than large meals.
• Avoid foods and drinks that trigger reflux, such as fatty or spicy foods, chocolate, caffeine, and alcohol.
• Don’t lie down right after eating and wait at least three hours before lying down after a meal.
• Elevate the head of your bed by about 6 to 8 inches to prevent acid from traveling back into the esophagus while sleeping.
• Quit smoking and avoid secondhand smoke.

Surgical Procedures:

• Nissen fundoplication: A surgical procedure where the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen it and prevent reflux.
• Linx surgery: A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus to strengthen the lower esophageal sphincter.

It’s important to consult with a healthcare provider for a proper diagnosis and to discuss the best treatment plan for you. If you’re experiencing new, severe, or persistent symptoms, it’s crucial to seek medical attention

Home-care Remedies:

Homecare remedies for Gastroesophageal Reflux Disease (GERD) can be quite effective in managing symptoms. Here are some strategies you can try at home:

Dietary Changes:

• Avoid food triggers: Common triggers include chocolate, alcoholic drinks, acidic foods like tomatoes and citrus fruits, coffee, spicy foods, fried or fatty foods, and mint.
• Eat smaller, more frequent meals: Large meals can put pressure on the lower esophageal sphincter and aggravate symptoms.
• Have dinner early: Eating your main meal at lunchtime and a lighter meal in the evening can help prevent nighttime reflux.

Lifestyle Adjustments:

• Weight management: Being overweight can increase the risk of GERD symptoms. Maintaining a healthy weight can help reduce this risk.
• Elevate the head while sleeping: Use pillows or raise the head of your bed to prevent acid reflux during sleep.
• Quit smoking: Smoking can decrease the lower esophageal sphincter’s ability to function properly.

Other Tips:

• Chewing gum: This can increase saliva production and may help neutralize acid.
• Sleeping on the left side: This position may reduce acid reflux.
• Breathing exercises: These can help reduce stress, which may in turn help reduce GERD symptoms.
• Herbal remedies: Some people find relief with herbal remedies like ginger.

It’s important to note that while these homecare remedies can help manage GERD symptoms, they are not a substitute for professional medical advice. If symptoms persist or worsen, it’s crucial to consult with a healthcare provider for appropriate treatment.