CONDITIONS
Gastroesophageal reflux disease (GERD)
What is gastroesophageal reflux disease?
Gastroesophageal reflux is a chronic condition in which stomach acid and other content move up into the oesophagus due to weakening of the lower oesophageal sphincter (LES), a ring of muscle at the bottom of the oesophagus. This reflux of gastric contents can irritate the oesophagus lining, leading to heartburn.
What are the risk factors for GERD?
- Having a hiatal hernia. It weakens the lower oesophageal sphincter and increases the risk of GERD.
- Being overweight
- Eating large meals or overeating
- Consuming citrus fruits, chocolate, caffeine, alcohol, carbonated drinks, or fatty or spicy foods
- Eating food right before bedtime
- Smoking
- Pregnancy
- Using certain medicines such as aspirin and ibuprofen
What are the symptoms of GERD?
The main symptom of GERD is heartburn, frequently described as a burning sensation in the chest, along with the regurgitation of sour or bitter fluids into the throat or mouth. The presence of both heartburn and regurgitation is a typical feature of GERD.
Other symptoms include:
- Non-burning chest pain, which is usually located in the middle of the chest and radiates to the back
- Feeling like a lump in the throat
- Difficulty swallowing
- Nausea and vomiting
- Tooth erosion
- Sore throat
- Breathing problems
- Unexplained dry cough
GERD symptoms can be worse:
- During nighttime or while lying down
- Following a large high-fat meal
- After bending forward
- After smoking or drinking alcohol
How is GERD diagnosed?
GERD is typically diagnosed by evaluating the individual’s symptoms, medical history and conducting a physical examination. Various tests are used to confirm the presence of GERD, such as:
- Upper gastrointestinal (GI) endoscopy and biopsy: A thin, flexible tube with a camera (endoscope) is passed through the mouth and into the oesophagus and stomach. The doctor can examine the esophagus and stomach lining for signs of inflammation, ulcers, or other abnormalities. They may also take tissue samples (biopsies) during the procedure to test for diagnosis purposes.
- Upper GI series: Also known as a barium swallow or barium meal, this test involves swallowing a chalky liquid containing barium, which coats the oesophagus, stomach, and duodenum. X-rays are then taken, which can reveal ulcers, inflammation, or other abnormalities.
- Oesophageal pH monitoring: This test checks for stomach acid in the oesophagus. During an upper endoscopy, a tiny capsule, similar in size to a gel cap, is temporarily attached to the wall of the oesophagus. This capsule is designed to monitor pH levels within the oesophagus and send this data to a receiver (resembling a pager) that is worn on the belt or waistband.
- Oesophageal manometry: This test measures the muscle activity of the oesophagus. A thin, flexible tube (catheter) is inserted into the nose, the oesophagus, and the stomach. It can confirm if the lower oesophageal sphincter or other muscles are working properly.
What are treatment options for GERD?
The management options for GERD are determined by the severity and frequency of symptoms and may include the following:
- Lifestyle changes: Making dietary adjustments, losing weight, elevating the head of the bed, and avoiding triggers can help alleviate symptoms effectively.
- Medications: Over-the-counter antacids, H2 blockers, or proton pump inhibitors (PPIs) may be recommended to reduce acid production or neutralize stomach acid.
- Surgical procedures: In cases of severe GERD where medications and lifestyle changes are not effective, surgical interventions such as fundoplication or placement of the LINX device may be considered to strengthen the LES.
- Fundoplication is a surgical procedure that involves increasing the pressure in the lower oesophagus by wrapping the top of the stomach around the LES This tightening of the muscle helps prevent reflux by raising the pressure in the lower oesophagus. The procedure can be done using a laparoscope or through open surgery.
- LINX surgery, on the other hand, involves the placement of a band made of magnetic titanium beads around the junction of the stomach and oesophagus. This band allows enough flexibility to allow food to pass into the stomach while maintaining tightness to prevent reflux.
How can one reduce the risk of GERD?
- Maintain a healthy weight: Excess weight, especially around the abdomen, can increase pressure on the stomach and lead to GERD. Losing weight, if overweight or obese, can help reduce the risk of GERD.
- Eat smaller meals: Eating smaller, more frequent meals throughout the day can help prevent excessive stomach distension and reduce GERD.
- Limit acidic and spicy foods: Acidic and spicy foods can irritate the oesophagus and worsen GERD symptoms. Limiting the intake of acidic foods like citrus fruits, tomatoes, and spicy dishes can help reduce acid reflux.
- Elevate the head of the bed: Raising the head of the bed by 6 to 8 inches can help prevent nighttime reflux symptoms. This angle helps keep stomach acid from flowing back into the oesophagus while sleeping.
- Quit smoking: Smoking can weaken the LES and increase acid reflux. Quitting smoking can improve overall health and reduce the risk of GERD and other related complications.
- Limit alcohol and caffeine: Alcohol and caffeine can relax the LES and promote acid reflux.
- Manage stress: Stress can exacerbate GERD symptoms by increasing stomach acid production and affecting digestive function. Practicing stress-reducing techniques such as meditation, deep breathing exercises, yoga, or counselling can help manage stress and minimize reflux symptoms.
In summary, gastroesophageal reflux disease (GERD) is a chronic condition where stomach acid flows back into the oesophagus, causing irritation and inflammation. It affects millions of individuals worldwide. Common symptoms include heartburn, regurgitation, chest pain, and difficulty swallowing. Lifestyle changes, medications, and, in severe cases, surgery are used for its management.
References
- Available from: https://www.webmd.com/heartburn-gerd/reflux-disease-gerd-1. Accessed on May 9th, 2024
- Johns Hopkins Medicine. Gastroesophageal Reflux Disease (GERD). Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/gastroesophageal-reflux-disease-gerd. Accessed on May 9th, 2024
- Cleveland Clinic. Acid Reflux and GERD. Available from: https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd. Accessed on May 9th, 2024
- American Society for Gastrointestinal Endoscopy. Diet and Gastroesophageal Reflux Disease. Available from: https://www.asge.org/docs/default-source/about-asge/newsroom/doc-gerd_infographic_final.pdf. Accessed on May 9th, 2024
- Cleveland Clinic. Esophagus: 48-Hour Bravo Esophageal pH Test. Available from: https://my.clevelandclinic.org/health/diagnostics/12042-esophagus-48-hour-bravo-esophageal-ph-test. Accessed on May 9th, 2024