Gastroesophageal reflux disease (GERD) is a condition where acid from the stomach comes up into the esophagus.
Many people experience acid reflux from time to time, but often get confused between acid reflux and chest pain. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week. While most people ignore it and take it lightly, experiencing GERD two or more times a week, is a chronic condition that’s not just uncomfortable, but can have long-term effects on your health.
Do you know more than 20% of the Indian population suffers from GERD? According to several surveys, the risk factors predisposing for GERD in the study population include increasing age and BMI, living in urban areas, lower educational level, and pan masala chewing. So let’s understand what is GERD? How it occurs, what are the symptoms and the treatment available.
What is Gastroesophageal reflux disease (GERD) ?
Gastroesophageal reflux disease (GERD) is a very common disorder of the digestive system that occurs when the contents of the stomach flow back into the esophagus(food pipe). Normally, the food we take passes through the mouth into the esophagus and then from the esophagus into the stomach.
There are two valves which control the flow of food from esophagus into the stomach – Upper esophageal sphincter (UES) and lower esophageal sphincters (LES). GERD is mostly caused due to a dysfunctioning LES. The LES either becomes weak or relaxes very frequently, allowing regurgitation of stomach contents into the oesophagus. Gastroesophageal reflux happens when the LES is weak or relaxes when it shouldn’t. This lets the stomach's contents flow up into the esophagus. As the stomach contains acid, backflow of its contents may irritate the food pipe, thereby producing intractable symptoms.
GERD is also known as acid reflux. In short, GERD occurs when the sphincter at the bottom of the esophagus becomes weak, or opens when it should not.It usually causes a burning sensation in the chest (heartburn), which radiates from the stomach till the throat.
Risk Factors of Gastroesophageal reflux disease (GERD) ?
One single cause of GERD can’t be ascertained. Multiple factors lead to its development. If you have following things, it’s most likely you will develop GERD problem
- If you take large meals as stretching of stomach can cause loosening of LES temporarily
- Hiatal hernia
- Being overweight or obese
What can trigger reflux? A lot, unfortunately. It’s not just county fair food but also your lifestyle
- Tobacco, Alcohol
- Tomato-based products
- Citrus Foods
- Spicy foods
- Fatty/greasy foods
- Carbonated beverages
- Onions, Garlic, Black pepper
- Eating too soon before bed
- Certain medications, including aspirin
Symptoms of Gastroesophageal reflux disease (GERD)
Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults.
➡Symptoms of GERD
- Acid regurgitation (re-tasting your food after eating)
- Difficulty or pain when swallowing
- Sudden excess of saliva
- Chronic sore throat
- Laryngitis or hoarseness
- Inflammation of the gums
- Bad breath
- Chest pain
If you have acid reflux at night, you may also have:
- A lingering cough
- Asthma that comes on suddenly or gets worse
- Sleep problems
Diagnosis of GERD
Gastroesophageal reflux disease is one of the most common conditions affecting more than 20 million people. Some symptoms of GERD overlap with symptoms of a heart issue, so it is important to know the difference
You can make the diagnosis of gastroesophageal reflux disease just by sitting at home.
The baking soda (sodium bicarbonate) and stomach acid (hydrochloric acid) create a chemical reaction in your stomach. The result of this reaction is carbon dioxide gas, which causes burping. So a burp within three minutes of drinking the baking soda solution may indicate an adequate level of stomach acid. A burp after three minutes (or not at all) may indicate a low level of stomach acid.
How to Take the Baking Soda Stomach Acid Test
1. First thing in the morning (before eating or drinking), mix 1/4 teaspoon of baking soda in 4 ounces of cold water.
2. Drink the baking soda solution.
3. Set a timer and see how long it takes you to burp. If you have not burped within five minutes, stop timing.
In theory, if your stomach is producing adequate amounts of stomach acid you’ll likely burp within two to three minutes. Any burping after three minutes may indicate a low acid level. If you find symptoms of high levels of stomach acid, consult a doctor soon.
Diagnosis of GERD is usually made on the basis of symptoms. However, if it doesn’t resolve after lifestyle modifications and treatment with medications, the doctor recommend one more of the following diagnostic tests:
Radiography: Commonly referred to as “Barium swallow test”. Here, the patient is given a solution of barium, after which X-ray of the upper GI tract is taken. This will help the radiologist in detecting any stricture/narrowing present in the oesophagus, stomach or small intestine.
Endoscopy: It is a procedure in which a fibre-optic tube is inserted into the stomach. The endoscope is inserted into the mouth and down into the throat. An endoscopy is used to check whether the surface of the esophagus has been damaged by stomach acid. It can also rule out more serious conditions that can also cause heartburn, such as stomach cancer.
Esophageal biopsy: During the endoscopy itself, the doctor may scrape the esophageal/stomach lining using a needle. The tissue sample is then sent for microscopic examination to detect the presence of cancerous cells.
Esophageal manometry: Manometry is used to assess how well lower esophageal sphincter (LES) is working by measuring pressure levels inside the sphincter muscle. During the test, patient will be asked to swallow some food and liquid to check the proper functioning of LES.
Using pH probe: A small tube with a pH sensor attached to its end is inserted through the nose into the oesophagus. The probe is connected to a digital recording system. The patient is asked to wear the probe for 24 hours. The tube is then removed and results collected from the DRS are compared against the normal values showing the amount of acid exposure in a pathological state.
Lifestyle & Dietary Changes
If you are diagnosed with acid reflux, changing your lifestyle is the first and best way to deal with the problem.
How to Manage Reflux with Lifestyle:
- Eat small, more frequent meals, rather than 3 large meals each day.
- Don’t lay down or go to bed within 2 hours of mealtime.
- Elevate the head of your bed 6-8 inches. You can do this by placing wooden blocks or a foam wedge under the mattress.
- Lose weight safely if overweight/obese.
- Reduce or eliminate alcohol consumption.
- Stop any tobacco use.
- Avoid tight-fitting clothing to reduce intragastric pressure
Treatment for GERD
Generally taking OTC medications offers significant relief. But, if the symptoms still persist, you need to check with your doctor.
Doctors usually prescribe the following medications as acid reflux treatment.
Drugs that neutralize the already produced acid: Antacid preparations such as Gelusil, Gaviscon, and Tums offer quick relief. However, chronic use produces side effects such as diarrhoea or constipation. Consult your doctor before taking any medications.
Drugs that decrease acid production:
1. H2 – receptor blockers: These drugs block the release of histamine - a stimulant of gastric acid secretion. These drugs block the acid secretion for 12 hours. Examples of H2 – receptor blockers: Cimetidine, Ranitidine, Famotidine etc
Use of these medications is associated with side effects such as, headache, nausea, flatulence (gas in the stomach) and dizziness
2. Proton- pump inhibitors (PPI): These drugs block the acid production more effectively and for a longer duration. PPIs are very effective if taken on an empty stomach.
Examples of PPIs: Rabeprazole, Omeprazole, Esmoprazole, Lansoprazole, Pantoprazole, etc If lifestyle changes or medications do not have the desired effect, and you still feel the same problem a gastroenterologist may recommend surgery.
Surgical treatments include:
Fundoplication: The surgeon sews the top of the stomach around the esophagus successfully leading at reducing reflux.
Endoscopic procedures: This procedure stitches to tighten the sphincter muscle, and radiofrequency, using heat to produce small burns that help tighten the sphincter muscle.
LINX surgery: Doctor wraps a band of magnetic titanium beads around the place where your stomach and esophagus meet. This magnetic attraction of the beads keeps it loose enough to let food pass through into the stomach, but tight enough to stop reflux.
GERD is a chronic disease. GERD affects people of all ages—from infants to older adults.
GERD is often characterized by painful symptoms that can undermine an individual’s quality of life. Various methods to effectively treat GERD range from lifestyle measures to the use of medication or surgical procedures.
Treatment usually must be maintained on a long-term basis, even after symptoms have been brought under control and should only be stopped after doctor’s consultation.
It is essential for individuals who suffer the chronic and recurrent symptoms of GERD to seek an accurate diagnosis, to work with their physician, and to receive the most effective treatment available as ignoring the symptoms can lead to more dangerous results causing tissue damage.
Dr. Ronak Malani
Gastroenterologist & Colorectal Cancer Specialist