What is GERD?
GERD stands for Gastroesophageal Reflux Disease. It is a condition in which stomach acid and digestive fluids flow back into the food pipe (esophagus).
Between the food pipe and the stomach, there is a valve called the Lower Esophageal Sphincter (LES). Normally, this valve remains closed and opens only to allow food to pass into the stomach. Its main function is to prevent stomach acid from coming back up.
When this valve becomes loose or weak, acid and partially digested food can reflux into the esophagus. This leads to symptoms such as heartburn, chest burning, and sour or bitter taste in the mouth, which can significantly affect a patient’s quality of life.
Why Does GERD Occur?
GERD usually occurs due to increased pressure in the stomach or weakness of the lower esophageal valve. Common causes include:
1. Increased Stomach Pressure
- Obesity or excessive body weight increases pressure inside the abdomen.
- This pressure pushes stomach acid upward into the esophagus.
2. Pregnancy
- During pregnancy, abdominal pressure increases, making acid reflux more common.
3. Hiatus Hernia
- The stomach is normally an abdominal organ.
- When a part of the stomach moves up into the chest cavity, it is called a hiatus hernia.
- Patients with hiatus hernia have a higher risk of developing GERD.
How Does Acid Damage the Food Pipe?
The inner lining of the stomach and esophagus is different:
- The stomach lining is made of columnar epithelium, which can tolerate acid.
- The esophagus is lined with squamous epithelium, which is sensitive to acid.
When stomach acid repeatedly comes in contact with the esophageal lining, it causes inflammation and swelling. This condition is known as esophagitis.
Symptoms of GERD
Common symptoms of GERD include:
- Heartburn (burning sensation in the center of the chest)
- Sour or bitter fluid coming into the mouth
- Difficulty in swallowing (dysphagia)
- Chest discomfort or pain
- Esophageal spasms
Chronic acid reflux can weaken the muscles of the esophagus and worsen swallowing problems over time.
How is GERD Diagnosed?
1. Endoscopy
- Performed under mild sedation to reduce discomfort
- Helps detect esophagitis, ulcers, Barrett’s esophagus, or hiatus hernia
2. Esophageal Manometry
- A thin catheter is inserted through the nose
- Measures the pressure and function of the esophagus
3. 24-Hour pH Study (Best Test for GERD)
- A small catheter with a pH sensor is passed through the nose into the esophagus
- The sensor records acid exposure over 24 hours
- The patient continues normal daily activities and diet
- A drop in esophageal pH confirms acid reflux
Treatment of GERD
1. Lifestyle Modifications
- Eat small, frequent meals
- Avoid lying down for at least 3–4 hours after meals
- Elevate the head end of the bed by 6–8 inches
- Sleep on the left side
- Avoid tight-fitting clothes
2. Dietary Changes
Avoid foods that increase acid reflux, such as:
- Oily and spicy foods
- Citrus fruits like oranges and lemons
- Chocolate
- Smoking and alcohol
3. Medications
- Medicines taken before meals to reduce acid production
- Syrups that form a protective barrier over stomach acid
- Most patients experience good symptom control with medication
When Medications Are Not Enough
Some patients experience a return of symptoms after stopping medicines, or acid reflux continues despite treatment. In such cases:
Valve Tightening Procedures
- Fundoplication Surgery:
The upper part of the stomach is wrapped around the food pipe to tighten the valve and prevent reflux.
- Advanced endoscopic techniques can also be used to strengthen the loose esophageal valve.
- Hiatus hernia, if present, can be corrected during these procedures.
Treatment of GERD Complications
- Esophageal Stricture: Treated with medications followed by balloon dilation
- Barrett’s Esophagus: Managed with medications and endoscopic therapy to prevent cancer
- Advanced lesions may require specialized endoscopic or surgical treatment
Conclusion
GERD is a common condition but can lead to serious complications if left untreated. With proper diagnosis, lifestyle changes, medications, and when required, surgical or endoscopic treatment, GERD can be effectively managed and controlled.
