Gastroesophageal Reflux Disease – GERD

Gastrooesophageal Reflux Disease (GERD) is caused due to a digestive dysfunction affecting the lower esophageal sphincter (LES) muscle that connects the esophagus and the stomach leading to a persistent regurgitation of the stomach’s contents into the esophagus.

The degree of severity of GERD is dependent on the LES disorder along with sort and quantity of fluid being refluxed into the esophagus and the defusing outcome of saliva.

Gastroesophageal Reflux Disease Causes:

• Certain doctors think that hiatal hernia- a condition wherein the stomach bulges into the chest cavity, tends to weaken the LES muscle and lead to gastroesophageal reflux. When one coughs, vomits, strains or any such kind of abrupt physical stress and exertion could raise the pressure in the abdomen leading to hiatal hernia.
• Overweight, pregnancy, stress.
• Consuming oversized quantities of foods and particularly onion, garlic, pepper, chocolate, tomato or tomato-derived foods, citrusy fruits, fatty or highly spiced food items, peppermint.
• Having particular drinks derived from citrus fruits, aerated drinks, caffeine or caffeine based drinks, alcohol, and smoking.
• Having meals just prior to bedtime and when one lies down or bends over particularly following a meal.
• Those who wear restricting clothes or belts.
• Those on particular medications, certain antibiotics, aspirin, NSADs like Aleve, Advil among others.

Gastroesophageal Reflux Disease Symptoms:

• Sensation of heartburn, known also as acid indigestion that normally seems like a strong pain in the chest area commencing at the backside of the breastbone, radiating up to the throat, quite often leaving an insipid after-taste in the mouth.
• The burning  sensation, pressure or discomfort lasting up to two hours, mostly worsening subsequent to a meal, most often mistaken for heart ailment or stroke.
• Children affected by GERD may persistently vomit, cough and have other respiratory distresses.
• Coughing, feeling of hoarseness or soreness in the throat. Swelling or Inflammation in the larynx and throat region.

Exams & Tests:

• A detailed physical exam of the throat and the larnyx is conducted by the doctor.
• X-rays are taken after the patient has been advised to ingest barium. This aids in detecting ulcer formations and presence of strictures.
• In certain cases of chronic esophageal reflux or with symptoms not curable by most treatments, a comprehensive and detailed diagnosis is crucial that involves employing testing methods like upper GI series, Upper Endoscopy test, Bernstein test, Esophageal manometric testing, Esophageal motility testing, Esophageal Acid Testing and Esophageal pH testing techniques.

Gastroesophageal Reflux Disease Treatment:

Treatment for GERD is aimed at reducing the quantity of reflux or minimising the harm done to the esophageal lining due to the recurrent reflux.

• Altering one’s way of life and diet.
• Keeping away from food items and drinks that tend to slacken the LES or might cause irritation of the esophageal lining.
• Restricting portion sizes during meals, keeping a gap of nearly three hours between meals and going to bed.
• Maintaining ideal weight and quitting smoking.
• Raising the headrest portion of the bedding on six inch slabs or alternatively using a specifically made wedge to sleep on that works on the principle of gravity to reduce reflux into the esophagus, thus lowering heartburn.
• Avoiding cushions for supporting oneself up, that mainly exerts strain on the stomach.
• Certain non-prescription antacids help in alleviating the undesirable symptoms by having a neutralizing effect, though for momentary periods of time. An antacid-alginic acid combo provide relief for many as it is forms a foam casing atop the stomach averting acid refluxing to take place.
• Protracted antacid consumption could lead to adverse side effects such as diarrhoea, an alteration in calcium metabolism in the body and magnesium accumulation in the body. Excessive magnesium accumulation in individuals with kidney ailments is known to be detrimental. If antacid consumption is needed for longer than three weeks, then prompt medical advice must be taken.
• To treat severe reflux and burning sensation in the heart, reflux-reducing medicines like H2 blockers including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac).
• A different form of drug known as the acid or proton pump inhibitor like esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex).
• Therapy that include the administration of motility medicines like cisapride, bethanecol, metoclopramide that improve LES muscle strength, hasten the stomach’s emptying process and target the gastrointestinal tract.
• The Stretta procedure is a widely popular, least invasive way to effectively treat GERD. This non-surgical option is undertaken by using a fine tubular structure, Stretta device that is lowered down till the esophagus, releasing high-intensity radio emissions used to tighten the LES.  Another minimally invasive choice that needs no medicines is endoscopic stitches.

Possible Complications:

• At certain occasions GERD is known to cause detrimental complications like Esophagitis due to excessive stomach acids being refluxed into the esophagus leading to esophageal blood loss or ulcer formations.
• Severe scarring could cause a tapering or constriction of the esophagus. In certain individuals there is considerable wounding of the esophageal lining leading to a condition called the Barrett’s esophagus, considered by many experts to be a harbinger of esophageal cancer.
• A minor population of individuals ailing from GERD need surgical intervention procedures like Fundoplication when most of the treatment options seem futile.

Prevention:

• Keeping away from food items and drinks that have an undue effect on the LES muscle or cause irritation in the esophageal lining.
• Reducing weight if obese, cessation of smoking.
• Raising headrest of the bed to nearly six inches.
• Trying not to lie down for two to three hours following a meal.
• Taking antacids if necessary.

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