Every one of us has experienced occasional gastroesophageal reflux when we burp, with an acid taste in our mouth or have heartburn. However, if these symptoms frequently (>2 times a week) and if it interferes with your daily life, then this becomes a diseased entity known as gastroesophageal reflux disease.In other words, GERD is the long-term, regular occurrence of GER.

Traditionally, GERD has been thought to be a disease of the western worlddue to its high prevalence of around 10–20%. In Asia, limited data showed that the prevalence was 2.5–6.7% and that most patients had mild disease. However,within the last decade, research in GERD showed that the prevalence of weekly heartburn ranges from 8 to 20%, which is higher than previous estimates. 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.

Now, why the reflux occurs?

When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again.

If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.

What are the symptoms of GERD?

Common signs and symptoms of GERD include:

• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• ‘Water brash’ which is salivation due to reflex salivary gland stimulation as acid enters the gullet, is often present.
• Sensation of a lump in your throat
• Bad breath

If you have nighttime acid reflux, you might also experience:

• Chronic cough
• Laryngitis
• New or worsening asthma
• Disrupted sleep

Who are at risk?

GERD occurs more commonly in people who are:

• overweight or obese because of increased pressure on the abdomen
• pregnant, due to the same increased pressure
• Hiatus hernia patients

What Factors can aggravate acid reflux?

• Smoking
• Eating large meals or eating late at night
• Eating certain foods (triggers) such as fatty or fried foods
• Drinking certain beverages, such as alcohol or coffee
• Taking certain medications, such as aspirin, pain killers
• Excessive stressful life

What Complications can occur if left untreated?

GERD can worsen and turn into other conditions if left untreated.
These include:

• Esophagitis: This is an inflammation of the esophagus.
• Esophageal stricture: In this condition, the esophagus becomes narrow, making it difficult to swallow.
• Barrett’s esophagus: The cells lining the esophagus can change into cells similar to the lining of the intestine. This can develop into cancer.
• Respiratory problems: It is possible to breathe stomach acid into the lungs, which can cause a range of problems including chest congestion, hoarseness, asthma, laryngitis, and pneumonia.

How GERD Diagnosis is made?

Anyone who is experiencing frequent acid reflux symptoms should talk to their doctor, who may refer them to a specialist in gut medicine known as a gastroenterologist for further investigation.

Being a Gastroenterology specialty hospital,Gem Hospital provide the best treatment and diagnosis for gastroesophageal reflux.

There are several possible tests to diagnose GERD, including:

• Upper gastrointestinal (GI) endoscope: This is a tube with a camera attached, which is used to inspect the esophagus. A small sample of tissue may also be taken at the same time in a biopsy.
• Esophageal pH and impedance monitoring: This measures the amount of acid in the esophagus while the body is in different states, such as while eating or sleeping.
• Esophageal manometry: This measures muscle contractions in the esophagus during swallowing. It can measure the strength of the sphincter.
• Radiological tests such as ultrasound scan of abdomen, Upper GI series or CT scan depending upon case scenario.

Treatment

Treatment depends on the severity of the disease. If mild, it is initially treated with medications (acid reducing medications such as PPIs) along with dietary and lifestyle modifications.

Other options include:

• H2 blockers: These are another option to help decrease acid production.
• Antacids: These counteract the acid in the stomach with alkaline chemicals. Side effects can include diarrhea and constipation.
• Prokinetics: These help the stomach empty faster. Side effects include diarrhea, nausea, and anxiety.
• Erythromycin: This is a type of antibiotic that also helps empty the stomach.

What changes in Lifestyle and behavior changes can help relieve GERD?

• Avoid the aggravating factors mentioned above
• Eat moderate amounts of food and avoid overeating.
• Avoid eating 2 to 3 hours before sleeping.
• Quit or avoid smoking.
• If a person is overweight, losing weight can help prevent symptoms.
• Do not wear clothing that is tight around the abdomen.
• Sleep at a slight angle with the head slightly elevated.

What are the other options if medications and diet didn’t help?

If lifestyle changes do not significantly improve the symptoms of GERD, or medications do not have the desired effect, a gastroenterologist may recommend surgery. In some cases, depending upon the severity of GERD, some patients will also be advised surgery upfront rather than waiting for response for medications.

Surgical treatments include:

Key hole ANTIREFLUX surgery called “Fundoplication