Gastro-esophageal reflux disease

Gastro-esophageal reflux disease (GERD) is a chronic, progressive, recurrent disease implying medical treatment.  It represents the most frequent disorder of superior digestive duct, one of the most common gastro-intestinal disease in now-a-days, with symptoms like heartburn and regurgitation that have a negative impact on patient’s daily activity.

In western countries, GERD is the most common gastrointestinal disease. It is associated with a huge economic burden and decreased quality of life. In addition, GERD can be associated with worrisome complications such as strictures, Barrett’s esophagus (BE) and rarely, Esophageal Adenocarcinoma (EAC).

Traditionally, GERD has been thought to be a disease of the western world. Prevalence rates have been estimated to be lower in Asia when compared to that of the western countries. In recent years, the progress in the Indian society on both socioeconomic and educational fronts has led to changes in diet and lifestyle choices. Nonetheless, the impact of adaptation of ‘western diet and lifestyle’, increasing obesity on increase in prevalence of GERD cannot be ruled out.

Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the lower oesophageal sphincter (LES), the ring of muscle between the oesophagus and stomach. Many people, including pregnant women, suffer from heartburn or acid indigestion caused by GERD. Some people suffer from GERD due to a condition called hiatus hernia.

Gastroesophageal refers to the stomach and oesophagus. Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return of the stomach's contents back up into the oesophagus.

In normal digestion, the Lower oesophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the oesophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach's contents to flow up into the oesophagus.

The severity of GERD depends on LES dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralizing effect of saliva.

Clinical features

• The major symptoms are heartburn and regurgitation, often provoked by bending, straining or lying down.
• ‘Water brash’ which is salivation due to reflex salivary gland stimulation as acid enters the gullet, is often present.
• Some patients are woken at night by choking as refluxed fluid irritates the larynx.
• Others develop odynophagia or dysphagia.
• A few present with atypical chest pain which may be severe, can mimic angina and is probably due to reflux-induced oesophageal spasm.

Complications

If it's not controlled, acid reflux or GERD can result in serious problems, including

• esophagitis,
• oesophageal bleeding and ulcers,
• Barrette's Oesophagus
• strictures
• An increased risk of oesophageal cancer.
• Iron deficiency anaemia
• Gastric volvulus

Treatment

The Allopathic system offers three main types of medicines to treat GERD. They are:

• Antacids
• H2RAs (histamine type 2 receptor antagonists) and
• PPIs (proton pump inhibitors).

Antacids stop heartburn by neutralizing (weakening) the acid in your stomach.They work quickly to treat mild GERD symptoms.

H2RAs and PPIs cause stomach to produce less acid. Less acid in stomach lowers chance of getting heartburn. H2RAs and PPIs work for a longer time than fast-acting antacids, but they do not start working as fast.

Management

Lifestyle advice includes

• Weight loss
• Avoidance of dietary items which the patient finds worsen the symptoms
• Elevation of the bed in those experience nocturnal symptoms
• Avoidance of late meals
• Giving up smoking
• Small volume, frequent feeds