GASTRO ESOPHAGEAL REFLUX DISEASE

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Fundamentals of Gastro Esophageal Reflux Disease

Gastro Esophageal Reflux Disease, abbreviated as GERD is basically a disorder, which affects the sphincter mechanism between the esophagus (food pipe) and your stomach.Normally the muscular ring between the lower end of esophagus and stomach, known as the Lower Esophageal Sphincter (LES) opens during swallowing and closes immediately so that food does not get back into the esophagus from the stomach. In this disorder, this sphincter mechanism is defective and thus acid and food from the stomach refluxes back into the esophagus to cause symptoms.Long standing reflux causes inflammation of the lower end of esophagus called esophagitis. It can also lead to ulceration, narrowing of the lower end of esophagus and Barrett’s esophagus (precancerous).

Risk factors for developing a Gastro Esophageal Reflux Disease

On a general note, these are the overall causes, for patients to develop GERD. And, they are

  • Hiatal Hernia – It’s a condition where the muscle that separates the chest and abdominal cavity is very lax and allows thus allows the stomach to bulge upward in to the chest.
  • Obesity
  • Pregnancy
  • Cigarette smoking
  • Eating chocolates, peppermint, fatty or fried foods can trigger dysfunction of LES
  • Age factor- Americans who are 50 and above can develop severe GERD or Hiatal Hernia

Symptoms associated with GERD

  • Burning sensation in your lower chest (Heart burn), which might reach up to the throat
  • Tightness in the chest or chest pain (Most common symptom of GERD)
  • Sour taste or liquid in your throat due to acid reflux ( this symptom is more pronounced while you are lying down or bending forward)
  • Feeling of food coming back into throat
  • Difficulty swallowing
  • Hoarseness
  • Dry cough

Diagnosis of GERD

The doctor performs few tests to diagnose Reflux disease in you, these include-

  1. Endoscopy- In an endoscopy, the doctor passes a lighted thin flexible tube with a video camera, fitted at the rear end, through your throat. The doctor can clearly view the inner most lining of the esophagus. Presence of esophagitis, ulcers or Barrett’s esophagus can be detected this way.
  1. Barium meal (Gastro Intestinal) X-Rays- This is a special test, where you are allowed to drink a liquid Barium solution and X rays taken immediately after you swallow to look for reflux.
  1. Biopsy- is another diagnostic evaluation, wherein a small sample piece of tissue is taken out from the lower end of esophagus during endoscopy to detect complications of Gastro esophageal reflux
  1. Esophageal motility or manometry studies, helps to identify movement and pressure within the esophagus and across the lower esophageal sphincter.
  1. 24 hour pH testing allows to detect when and for how long acid refluxes back into your esophagus.

Gastroesophageal Reflux DiseaseTreatment options for curing GERD

The treatment usually starts off with over the counter medicines to neutralize or control the acid reflux

Medical Treatment – Your doctor gives you strong medicines called proton pump inhibitors to reduce acid production. These provide symptom relief for up to 12 hours. These medicines probably have to be taken lifelong.

Antacids are medicines that neutralize the acid and may provide quick symptomatic relief. Diarrhea and constipation are side effects of antacid overuse.

Drugs to improve the function of the lower esophageal sphincter mechanism include calcium channel blockers and nitrates.

Life style changes - One would need to avoid factors that promote reflux, like avoiding spicy and fatty foods and lying down with head end of bed raised or using extra pillows.

If medical treatment and life style changes don’t work out, surgery is the best and definite treatment of this problem.

Laparoscopic Nissen’s fundoplication – It is the gold standard procedure and is performed by laparoscopy (key hole surgery) in most centers. It involves strengthening the lower esophageal sphincter by wrapping the upper end of stomach around the lower end of esophagus. This would prevent acid reflux and relieve your symptoms.

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