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GASTROESOPHAGEAL REFLUX (GERD)

GERD is the digestive disorder in which the stomach content flows back into the food pipe or esophagus. This condition occurs when lower esophageal sphincter, a ring between esophagus and stomach is affected. As the stomach contains acid, backflow of its contents may irritate the food pipe, thereby producing intractable symptoms. It affects people of all ages, from infants to older adults, and pregnant women usually suffer from heartburn and indigestion caused by GERD. GERD can be easily managed through diet and life-style changes but few people require strong medications or even surgery to reduce the symptoms.

Symptoms

Heartburn, also called as indigestion is the most common symptom of GERD which usually feels like burning in the chest that radiates to the neck and throat. This symptom usually lasts for 2 hrs and may get worse after eating.  Other symptoms include:

  • Feeling of a lump in the throat
  • Hoarseness of voice
  • Difficulty swallowing
  • Burping, associated with acid/bitter aftertaste in the mouth
  • Dental caries
  • Bad breath

If the chest pain increases with physical activity such as bending, then it is due to an underlying cardiovascular complication. Else, it is less likely that GERD produces chest pain upon physical activity. Meet the doctor if there are symptoms of chest pain, shortness of breath, and arm pain because they may be the symptoms of heart attack.

Causes

GERD mainly occurs when lower esophageal sphincter becomes weak or relaxes, causing stomach contents to come back into the esophagus. This may be due to various factors like increased pressure on the abdomen,

  • A hiatal hernia – pushing of stomach upwards through the diaphragm
  • Large meals: stretching of stomach can cause loosening of LES temporarily
  • Obesity
  • Stress (smoking)
  • Junk foods, such as chocolate, carbonated drinks, chewing gums, fatty foods, etc

If heartburn is observed only after taking certain foods, it is better to avoid them or eliminate them from the diet.

Risk factors

GERD is a common condition observed in all the age groups, however, it is rarely seen in children. The risk factors of GERD include:

  • Alcohol use
  • Hiatal hernia
  • Obesity
  • Pregnancy
  • Scleroderma
  • Smoking
  • Dry mouth
  • Delayed stomach emptying

Complications

GERD should be treated whenever noticed. If the condition persists for longer time, it may lead to complications like narrowing of the esophagus, esophageal ulcers, and Barrett’s esophagus.

Diagnosis

Diagnosis of GERD is based on the symptoms such as heartburn. Various other tests are recommended for confirming the diagnosis.

  • X-ray of the digestive system
  • Endoscopy- An endoscope is sent into the esophagus look at the lining of the esophagus and stomach. Inflammation in the esophageal lining may be due to GERD
  • Ambulatory acid pH test- Monitors the amount of acid in the esophagus
  • Radiography- commonly referred to as “Barium swallow test”. In this test, the patient will be given a solution of barium, after which X-ray of the upper GI tract is taken to detect any stricture or narrowing in the esophagus, stomach or small intestine.
  • Esophageal biopsy- Using an endoscope, a tissue sample is taken which is sent for microscopic examination to detect the presence of cancerous cells
  • Manometry test- A catheter is inserted into the nose and esophagus to check the pressure and movement in the esophagus.

Treatment

Lifestyle and dietary management can help reduce the amount of reflux and damage to the lining of the esophagus. If the patient does not feel relief within few weeks, the physician may recommend other treatment options like medications and surgery.

Lifestyle and dietary changes

  • Food such as chocolates, peppermint, fatty foods, coffee, and alcoholic beverages should be avoided. The foods that irritate and damage the esophageal lining such as citrus fruits and juices, tomato, and pepper should also be avoided.
  • Reduce the size of the meals to reduce the reflux symptoms
  • Eat 2 to 3 hours before bed time would be beneficial as it reduces the amount of acid secretion
  • Avoid cigarette smoking as it weakens lower esophageal sphincter
  • Do not use pillow while sleeping as it increases pressure on the stomach region

Medications

Taking OTC medications offers significant relief. Doctors usually prescribe the following medications for acid reflux treatment:

  • Antacids- to neutralize the stomach
  • H2- receptor blockers- these drugs provide long-term relief and reduce acid production up to 12 hrs, ex: cimetidine, ranitidine, famotidine etc.
  • Proton pump inhibitors- These drugs block the acid production more effectively and for a longer duration. PPI’s are very effective if taken on empty stomach. Examples are rabeprazole, omeprazole, esomeprazole, lansoprazole, pantoprazole, etc
  • Medications to strengthen lower esophageal sphincter such as baclofen may also be given to reduce GERD.

Surgery

Surgery is proscribed only when the medications do not work. Surgery also prevents long-term medication use. Surgery is usually performed to tighten and strengthen the lower esophageal sphincter to prevent the reflux of stomach content into the esophagus.

Prevention

Making certain lifestyle changes can help prevent the heartburn and GERD.

  • Do not overeat; instead, have small and frequent meals
  • Quit smoking
  • Have adequate sleep
  • Maintain healthy weight
  • Avoid foods that trigger heartburn
  • Avoid sleeping immediately after eating
  • Avoid tight-fitting clothing
  • Elevate the head of the bed while sleeping
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