Author: Dr. Jino Thomas 
MBBS, MD, DM (Gastroenterology) : Senior Consultant Gastroenterology

GERD Gastroesophageal Reflux Disease

The esophagus is a tube that carries the food we eat from the  throat to the stomach. GERD, or esophageal reflux disease, is a  condition in which stomach acid, or sometimes bile, backs up  into the esophagus (reflux).  

Symptoms

1. Heartburn - The most common symptom is a burning or  burning sensation in the middle of the chest or throat.
2. Regurgitation (reflux) - feeling of sour water coming up into  the throat or mouth. 
3. Chest Pain - Some may experience symptoms like severe  chest pain or heaviness in the chest. This may be considered a  cardiac symptom.   
4. Some people may experience pain or slight obstruction when  swallowing.This is more common in those with more  inflammation and peeling of the esophagus (esophagitis). 
5. Symptoms of dry cough, hoarseness and wheezing can be  caused by inflammation in the throat caused by acid.

The basis

At the junction of the esophagus and the stomach there is a  mechanism to prevent food and acid from flowing back into the  esophagus. It depends on the action of various muscles here.  Disorders in this system (antireflux mechanism) are the basic  cause of GERD.  

Other reasons

1. Hiatus Hernia – A hiatus hernia is a condition in which the  upper part of the stomach protrudes into the chest and is a  major cause of persistent acid reflux.  
2. Obesity - Obesity can increase pressure inside the stomach  and cause GERD to worsen.
3. Pregnancy – During pregnancy, abdominal pressure increases  and various hormones affect the muscles that prevent reflux.  This makes GERD more common. 
4. Smoking – weakens muscles and aggravates GERD. 
5. Medications - Pain relievers, hormonal medications, and  certain medications for pressure and asthma can aggravate  GERD.  

Diet and GERD

1. Eating on an empty stomach and eating late at night  aggravates GERD. 
2. High fat food Spicy and sour food, alcohol, coffee, tea and  chocolate cause GERD to worsen.

Complexities

1. Esophagitis – Esophagitis is an inflammation of the lining of  the esophagus.  
2. Barrett's esophagus - esophagus with constant acidity The  skin becomes similar to the skin of the small intestine.
   (Intestinal Metaplasia). This increases the risk of developing  cancer over time.
3. Continued inflammation of the esophagus can cause  narrowing of the esophagus, which can obstruct the passage of  food.

Diagnosis

In most patients, the diagnosis can be made from symptoms  alone. In some patients, tests may be required for diagnosis.

1. Endoscopy (OGD SCOPY)
   Esophageal inflammation, Barrett's esophagus and hiatus  hernia can be diagnosed in detail through endoscopy.
2. Barium esophagogram
   An X-RAY is used to take pictures of the esophagus while barium  is swallowed. 
3. Esophageal PH test
   A small wireless receiver is placed in the esophagus and the pH  (acidity) is measured for 24 hours. Through this, it is possible to  clearly know whether the lumps in the chest are due to acidity. 
4. Esophageal manometry (motility test)
   Sensors in a small tube passed through the nose can measure  pressure in the esophagus and understand muscle activity.  

Treatment

• Lifestyle modification – A good percentage of patients can  control the disease through proper lifestyle changes.  
• Lose weight  
• Avoid alcohol and smoking  
• Proper diet - eat small amounts and more often. Avoid fatty  foods, coffee, tea, spicy and tamarind foods as much as possible  which aggravate GERD. 
• Avoid tight clothing that puts too much pressure on the  abdomen.
• When lying down, keep your chest and head elevated 30  degrees.

Medicines

Anti-acidity drugs are mainly used in chichi tsa. Many types of  drugs are available today. These are very effective in controlling the disease. These medicines should be used judiciously as prescribed by the doctor. Uncontrolled continuous use of drugs should be avoided as much as possible.

1. Antacids – Reduces acidity and provides immediate relief. 
2. H-2 receptor blocker – reduces acid production. Example - Ranity Din  
3. Proton pump inhibitors -Strongly inhibit acid production is the most effective. Examples are omiprazole and pantoprazole.
4. Potassium channel blocker - Newly developed drug that  reduces acid production. Example - Vonoprasan.     

Surgery

Surgery may be considered in patients who require constant  medication and in those who have complications from GERD.  Surgery is also effective in those with significant hiatus hernias.  A keyhole fundoplication is the most commonly performed  surgery.

In short, GERD is one of the most common diseases in our  society. Most of the disease can be controlled through proper  diet and lifestyle. Medicines should be used rationally and  unnecessary use should be avoided.