Gastroesophageal reflux

Gastroesophageal reflux (GERD) is consequence of failure of the normal antireflux barrier of the lower esophageal sphincter system Hiatus hernia impairs the function of lower esophageal sphincter and has been implicated as causative factor in patients with severe GERD. Spectrum of GERD varies from mild heartburn with normal endoscopic findings and no esophageal mucosal disease to esophageal ulcerations, bleeding, stricture and dysphagia. Prolonged GERD can lead to Barrett’s esophagus which is risk factor for esophageal dysplasia and cancer

Symptoms of GERD are

• Retrosternal burning pain
• Dysphagia-difficulty in eating
• Odynophagia- pain during eating
• Upper GI bleed

Diagnosis

• In patients with classical GERD symptoms, diagnosis is straight forward, and no further testing is
  required
• In patients with severe symptoms such as dysphagia and bleeding, endoscopy is required to establish the
  diagnosis and rule out other causes
• Barium swallow, 25 hour pH testing, maonometry are the other tests which are helpful in diagnosis

Treatment

• Lifestyle modification
• Stopping smoking and alcohol
• Avoiding tight cloths
• Raising head end of bed
• Weight reduction
• Avoiding bed time snacks
• Avoiding Tea/coffee/cola/citrus fruits

Medications

• PPI and prokinetic agents are effective medications for control of symptoms
• Surgery
• Fundoplication is the procedure which corrects the physiological processes causing GERD
• Indication of surgery
• Patients doing better on PPI, but want to avoid long term use of medications
• Young patients with recurrent stricture