Gastro Esophageal Reflux Disease

Introduction
Gastroesophageal reflux disease (GERD) is a chronic disease of digestive
system in which the stomach acid flows backward into your food pipe. This
backward flow of stomach content causes irritation in the lining of your
esophagus and may feel like burning sensation in heart so called heart burn.

Signs & Symptoms

Heartburn (Burning sensation in the chest, just behind the breastbone)

Regurgitation (Expulsion of material from the pharynx or esophagus)
Nausea (Uneasiness of stomach / feeling of vomiting)
Chest pain (Pain in the chest usually in the upper central abdomen)
Troubles swallowing food
Sensation of lump in the throat
Coughing
Sore throat

You should seek immediate medical attention if you experience chest pain
along with other signs and symptoms like shortness of breath or pain radiating
to left arm or jaw. These may be signs and symptoms of a heart attack.
If you experience any of these signs and symptoms for at least twice each
week or interfere with your day to day life see your doctor.

Causes
GERD is caused by frequent back flow (reflux) of stomach acid or bile in to the
food pipe (esophagus). There is a circular band of muscle at the lower end of
esophagus where the esophagus enters the stomach which creates a valve like
mechanism known as lower esophageal sphincter that prevents the back flow
of stomach content in to food pipe. If this valve weakens or functions
abnormally, stomach acid can flow back in to your food pipe causing the signs
and symptoms of GERD and may disrupt your day to day life. If the backward
flow of stomach acid persist for longer time it causes inflammation of
esophagus (esophagitis) which leads to erosion of the esophagus, causing
multiple complications such as bleeding or breathing difficulty.

Dr. Sanjiv Haribhakti

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Risk Factors
Lifestyle and dietary habits may contribute to GERD. Certain foods and drinks
can trigger back flow of stomach content such as fried or fatty foods, alcoholic
drinks, coffee etc.
Following risk factors can increase your risk of GERD

Asthma
Pregnancy
Hiatal Hernia
Diabetes
Obesity
Smoking
Delayed stomach emptying
Zollinger Ellison syndrome

Complications
If the GERD persist for longer time, it may lead to various complications like:
Esophageal Ulcers: An open sore (ulcer) may form in the food pipe
(esophagus) over time due to severe erosion of tissues in the esophagus from
acid exposure. This ulcer may bleed causing pain and difficulty in swallowing.
Esophageal Strictures: The damage of esophageal cells near the junction
with the stomach may leads to formation of scar tissues. This will narrows the
food pathway causing dysphagia (difficulty swallowing).
Barretts Esophagus: The tissue lining of lower food pipe changes in color
and composition which is associated with the increased risk of esophageal
cancer.

Diagnosis
24 hours pH metry: The current gold standard for diagnosing GERD is 24
hours esophageal pH monitoring, in this technique a thin tube is being inserted
in to the food pipe through nose at the level of lower esophageal sphincture
and kept for 24 hours which records the pH. This is the most objective test to
diagnose GERD.
X-ray of upper digestive tract (Barium swallow): In this procedure you
have to swallow a contrast liquid and the x-ray technician visualizes the upper
digestive tract. This procedure helps in detecting presence of hiatal hernia or
narrowing of esophagus at lower part. However this is not very accurate in
determining inflammation of esophagus or if the presence of barretts
esophagus.
Upper Endoscopy: During endoscopy an endoscope (a thin flexible tube
Dr. Sanjiv Haribhakti

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equipped with light and camera) is passed in to esophagus, stomach and small
intestine through mouth. This will allow direct visualization of upper digestive
tract to check for potential damage such as ulcer, inflammation of esophageal
lining. This also allow the doctor to take sample tissue for further examination
to determine any pre cancerous signs (Barretts esophagus).
Esophageal Manometry: This test helps in determining the motility and
pressure in the esophagus. In this procedure a small tube is inserted down the
esophagus through nose. After placing the tube, patient is asked to swallow
water at regular interval. The pressure reading of the esophageal muscle
contractions (motility) is recorded. This procedure helps in determining any
problem with motility of esophagus or lower esophageal sphincture.

Treatment
Long term and appropriate medical therapy is usually necessary to bring the
symptoms under control and to prevent various complications of GERD like
esophageal stricture and Barretts esophagus.
Treatment options usually include lifestyle modifications, medications, surgery
or combination of it.
Lifestyle Modifications: Change in lifestyle and dietary habits can help in
maintaining the remission and improving quality of life. Avoidance of certain
diet such as spicy foods, acidic foods, fatty foods, alcoholic drinks, coffee etc
may help in reducing the signs and symptoms of GERD. Moderate exercise may
help in improving the symptoms however you should avoid vigorous exercise
as it may worsens the condition. Maintaining an upright posture after taking
meal may help in preventing back flow of stomach acid. If you frequently
experience heartburn in bed at night you should avoid lying down within 3
hours of taking meal. Avoid large meals as it will empty slowly from the
stomach and exerts pressure on the lower esophageal sphincture. Take small
meals at frequent intervals.
Medications: the most commonly used medications for GERD are proton
pump inhibitors, H2 receptor blockers and antacids. Proton pump inhibitors
(PPI) are the most effective drugs in controlling GERD symptoms. It inhibits the
production of acid in stomach. H2 receptor blockers reduce the production of
acid in stomach. They are less effective in controlling the GERD symptoms
compared to proton pump inhibitors. Antacids provide quick relief by
neutralizing stomach acid for shorter duration.
Surgery: Surgery is required when long term medical treatment is ineffective
or undesirable or when certain complications of GERD are present. The most
commonly used surgery for GERD is Nissen Fundoplication which involves
tightening of the lower esophageal sphincture by wrapping the top portion of
stomach around the outside of lower esophagus.

Dr. Sanjiv Haribhakti

Gisurgery.info