By Dr Ritesh Kohli, MD
(Consultant Internal Medicine)
What is GERD?
Gastroesophageal reflux disease (GERD) is the abnormal backflow of stomach acid up into the food-pipe − the long, muscular tube that connects the back of the mouth to the stomach. The muscle at the border of the food-pipe and stomach, called the sphincter, works as a gate that is normally closed to prevent the contents of the stomach from washing up into the food-pipe, and opening only when you swallow. Gastroesophageal reflux occurs when the stomach contents reflux or come up into the food-pipe and/or mouth causing troublesome symptoms.
Symptoms
● Heartburn or a sour taste in the mouth
● Pain occurring in the middle of the chest
● Coughing and/or choking while lying
● Increased trouble in breathing while asleep
● Difficult and painful swallowing
● Persistent hoarseness of voice
● Cough over a long period of time, or new onset asthma, or asthma only at night
● Dyspepsia. Up to half of GERD patients have dyspepsia, a syndrome consisting of the
following:
○ Pain and discomfort in the upper abdomen
○ Fullness in the stomach
○ Nausea after eating
Doesn’t everyone suffer from heartburn from time to time?
Almost everyone experiences heartburn from time to time, especially after a large meal. However, if heartburn is troublesome enough to affect a patient’s well-being (for example, by making it difficult to sleep or painful to exercise), this may indicate GERD.
What causes GERD?
Normally, the stomach contents are prevented from refluxing into the esophagus by a ring of muscle, called the lower esophageal sphincter (LES). This acts as a one-way valve, which allows food to enter the stomach but not to exit the same way. Sometimes the LES is not completely effective and allows the stomach contents back into the esophagus, where the stomach acid can cause irritation to the lining of the food-pipe leading to GERD. Other factors that may contribute to GERD include
● obesity
● pregnancy
● smoking
Common foods that can worsen reflux symptoms include
● citrus fruits
● chocolate
● drinks with caffeine or alcohol
● fatty and fried foods
● garlic and onions
● mint flavourings
● spicy foods
● tomato-based foods, like spaghetti sauce, salsa preparations, red pepper
● pizzas
Why is GERD common in pregnancy?
Pregnant women are particularly vulnerable to acid reflux disease. The symptoms typically get worse in the third trimester when the enlarged womb pushes on the stomach. Hormones during pregnancy also cause the digestive system to work more slowly and make the lower esophageal sphincter relax more often. Symptoms typically disappear after childbirth.
Diagnosis
GERD is usually diagnosed based on symptoms and the response to treatment. In people who have symptoms of reflux but no evidence of complications, treatment with lifestyle changes and in some cases, a medication, is often recommended, without testing. Specific testing is required when the diagnosis is unclear or if there are more serious signs or symptoms as described above.
Endoscopy — An upper endoscopy is commonly used to evaluate the esophagus. A small, flexible tube is passed into the food-pipe, stomach, and small intestine. The tube has a light source and a camera that displays magnified images of these structures.
How is GERD treated?
Depending on the severity of your GERD, treatment may involve one or more of the following:
Lifestyle changes
● If you smoke, stop.
● Avoid foods and beverages that worsen symptoms.
● Lose weight if needed.
● Eat small, frequent meals.
● Wear loose-fitting clothes.
● Avoid lying down for 3 hours after a meal.
● Raise the head of your bed 6 to 8 inches by securing
wood blocks under the bedposts. Just using extra
pillows will not help.
Medication
Antacids and drugs that reduce stomach acid production are used. Consult your health care provider before starting or adding a medication.
Does GERD require surgery?
A small number of people with GERD may need surgery because of severe reflux and poor response to medical treatment. Fundoplication is a surgical procedure that increases pressure in the lower food-pipe. However, surgery should not be considered until all other measures have been tried.
Is it heartburn or a heart attack?
One of the symptoms and conditions that might be confused with GERD is chest pain due to heart disease. However, there are some differences.
The classic description of a heart attack is crushing, heavy or dull pain below the chest bone that may extend up to the neck, shoulders or arms, and shortness of breath. The pain is usually relieved with a drug called sorbitrate.
The chest pain with GERD is typically burning and may extend upward. Pain due to GERD usually occurs after meals and is often relieved by antacids. However, the pain can be so similar to that of chest pain that it is often difficult or impossible to distinguish between the two without sophisticated testing.
NOTE: The symptoms of chest pain that accompany a heart attack are notoriously inconsistent with the classic description, especially in women, who often present with atypical pain, such as abdominal or back pain. If pain lasts for more than few minutes, do not try to diagnose yourself but seek immediate medical attention.
Conclusion
Although GERD can limit daily activities and productivity, it is rarely life-threatening. With an understanding of the causes and proper treatment most people will find relief.
