Gastro-esophageal Reflex disease (GERD) also known as acid reflux is a condition in which the contents of the stomach rises into the esophagus i.e. the food pipe, causing inflammation, irritation and burning sensation.
GERD is a chronic disease which has various symptoms and complications, but can be treated easily.
SIGNS & SYMPTOMS OF GERD
- Regurgitation i.e. the expulsion of undigested food and blood from the esophagus.
- Heartburn i.e. burning sensation in the chest.
- Pain while swallowing.
- Sore throat.
- Acid burps
- Increased salivation.
- Burping, crying, spitting, wheezing, etc in children.
- Decay & erosion of the surface of the teeth & enamel.
- Bad breath.
- Dry mouth.
Acid reflux occurs due to incomplete closure of the lower esophageal sphincter. Factors that contribute to acid reflux are:
- Hiatal hernia i.e hernia of the abdominal organs (typically stomach) causing GERD.
- Obesity: Increased body massage index has been linked to more severe GERD
- Formation of gallstones, as they obstruct the flow of bile (secretion of the gallbladder) into the duodenum, thus unable to neutralize the acid leading to acid reflux.
- Obstructive sleep apnea: It is a condition in which the patient faces pauses or shallow breathing while sleeping.
- Hiatal hernia
- Delayed stomach emptying time.
- Excessive consumption of alcohol .
- Eating large meals or late at night.
- Eating certain foods such as fatty or fried food.
- Consumption of carbonated beverages.
- Taking certain medications such as aspirin.
- Stress & Depression.
- Infection by H.Pyroli
COMPLICATIONS ARISING FROM GERD
Over time as the condition progresses, the following complications may be seen:
- Esophagus stricture o.r. narrowing of the esophagus.
- Esophageal ulcers: Due to the wear and tear of tissue by the acid, sores and ulcers may form in the esophagus.
- Esophagitis: Inflammation of the esophagus.
- Peptic ulcer.
- Barrett’s esophagus: abnormal change in the lining of the esophagus
- Esophageal Cancer.
Once symptoms are confirmed, the diagnosis for GERD is done as follows:
- Esophagogastroduodenoscopy ( EGD): It visualizes using an endoscope, the esophagus down to the duodenum.
- Biopsy of the Esophageal tissue to check presence for presence of tumors & inflammation.
- Ambulatory esophageal pH monitoring: The rate of regurgitation of the stomach acid is monitored using a clip or monitor.
- Barium swallow X rays: The esophagus can be visualized easily by this procedure, hence any narrowing of the esophagus can be detected.
- Esophageal manometry: This measures the force and coordination of the muscle contractions of the esophagus when a person swallows.
TREATMENT & PREVENTION OF GERD
- Lifestyle changes
- Weight loss
- Reduced sugar intake
- Increased fiber intake
- Avoiding fatty & spicy foods
- Lower intake of coffee
- Quit smoking
- Less or no consumption of alcohol
- Regular moderate exercise
- Improving sleeping habits
- Proton pump inhibitors e.g. Omeprazole
- H2 receptor blockers e.g. ranitidine
- Antacids e.g. Magnesium-Aluminium antacids
- Menthol solutions
- Sodium Bicarbonate acidity relieving powder
- Surgical procedures
- Nissen fundoplication: In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.
- Esophagogastric dissociation: This procedure is usually performed on neurologically impaired children. It is an alternative method, proven more efficient for such type of patients.
- A device called the LINX, which consists of a series of metal beads with magnetic cores may be used. They are placed surgically around the lower esophageal sphincter.This method is a good alternative for patients with severe symptoms and when other methods have not worked.