Gastroesophageal reflux disease or GERD is a common disorder with everyone suffering from it at least once in their life. According to the statistics, it nearly 70 million people of America getting affected each year. Although, this disease is more common in older people, age has no association with it and it can affect people belonging to all age groups. Gastroesophageal reflux disease (GERD) is more commonly known as Acid Reflux or Acid Regurgitation.

The gastroesophageal reflux disease (GERD) occurs when stomach contents including the harsh peptic acids, rises up into the esophagus due to the malfunction of the lower esophageal sphincter (LES). The esophagus is a hollow tube of about 25 cm in adults and extending from the back of the mouth up to the stomach. The esophagus functions as a passage to for the food to reach the stomach. The lower end of the esophagus contains a valve like sphincter, known as the lower esophageal sphincter (LES), between the junction of the esophagus and the stomach. The function of the lower esophageal sphincter (LES) is to prevent stomach contents from entering the esophageal tube. However, if the lower esophageal sphincter (LES) opens up spontaneously for varying periods of time, or if it does not close properly, gastroesophageal reflux disease (GERD) results.

As the stomach acid that is refluxed comes in contact with the epithelial lining of the esophagus, resulting in a condition commonly known to all of us as the heartburn or indigestion. As a results, a burning sensation in the upper abdomen that extends into the chest. Although the heart has got nothing to do with it, it is often associated with angina.

Heartburn is common and does not necessarily imply that one has gastroesophageal reflux disease (GERD). It is the presence of persistent reflux occurring more than twice a week is considered to be worrisome, as it can lead to some more serious medical conditions.

Signs and Symptoms of Gastroesophageal Reflux Disease:

Heartburn producing a severe burning in the chest with a sour taste in the mouth, and often mistaken for a heart attack. Chest pain which increases while lying down flat, especially at night. Dysphagia – difficulty in swallowing Coughing, wheezing, asthma, hoarseness or sore throat Regurgitation of food.

Causes of Gastroesophageal Reflux Disease:

As the person swallows the food, it passes through the esophagus where the lower esophageal sphincter (LES) relaxes to allow the food to pass into the stomach.

sphincter then closes again to prevent the reflux. Abnormal relaxation of the valve or a weakened can cause the reflux of the stomach contents, causing heartburn which worsens while bending down or lying flat.

Gastroesophageal reflux disease (GERD) is produced when constant reflux causes irritation and inflammation of the esophagus. The constant irritation to the epithelial lining of the esophagus causes esophagitis which can further get eroded. This result in bleeding, vomiting of blood, difficulty in swallowing known as dysphagia, or even difficulty in breathing known as dyspnea. The sphincter then closes again to prevent the reflux. Abnormal relaxation of the valve or a weakened can cause the reflux of the stomach contents, causing heartburn which worsens while bending down or lying flat.

Gastroesophageal reflux disease (GERD) is produced when constant reflux causes irritation and inflammation of the esophagus. The constant irritation to the epithelial lining of the esophagus causes esophagitis which can further get eroded. This result in bleeding, vomiting of blood, difficulty in swallowing known as dysphagia, or even difficulty in breathing known as dyspnea.

Another condition closely related to GERD is called Hiatal Hernia or diaphragmatic hernia. In this condition, some part of the stomach is protruding through the diaphragm into the chest. In cases of large protrusion, it further weakens the muscles of the lower esophageal sphincter, worsening the heartburn. A hiatal hernia occurs commonly in healthy people over age 50, though it can occur in all ages. And, it is very rare that a hiatal hernia will produce any symptoms at all.

Some other factors may contribute to GERD which include obesity, pregnancy, and smoking. Moreover, some common foods can also worsen the symptoms of reflux. These include citrus fruits, chocolate, drinks with caffeine or alcohol, fatty and fried foods, garlic, onions, mint flavorings, spicy foods, and tomato-based foods.

Some medicines can also be the cause of GERD including calcium channel blockers for high blood pressure, progestin for abnormal menstrual bleeding or birth control, anticholinergics, certain bronchodilators, tricyclic antidepressants, dopamine for Parkinson’s disease, sedatives for insomnia or anxiety, or beta blockers for high blood pressure or heart diseases.

When to see a Doctor:

If you have constant heartburn several times a week. Heartburn even while you are taking antacid Heartburn which cause you to wake up at night Dysphagia or difficulty in swallowing Weight loss Regurgitation of blood Melena or black stools.

Lifestyle Modifications that can Prevent GERD:

Avoid foods that trigger reflux. Start eating smaller meals. Avoid going to bed within 2-3 hours after eating a meal Avoid exercise or bending after eating. Lose weight. Avoid smoking. Sleep with you head elevated to at least 6 inches. Avoid tight-fitting clothes/belts. Reduce stress.

Treatment:

Over-the-counter Drugs:

Mild heartburn can be treated with an over-the-counter (OTC) medication which includes:

1. Antacids: they neutralize stomach acid and can provide quick relief. Side-effects are diarrhea or constipation.

2. H-2-receptor blockers: they help by reducing the production of acid. They are not quick acting though they provide relief for longer periods. Side effects include bowel changes, dry mouth, dizziness or drowsiness.

3. Proton pump inhibitors: they block the production of acid production.

Prescription Drugs:

Prescription drugs are helpful when you have frequent and persistent heartburn resulting in an inflamed esophagus. The main prescription drugs are:

1. Prescription-strength H-2-receptor blockers: these drugs reduce acid production and have fewer effects.

2. Prescription-strength proton pump inhibitors: these are the most effective and long-acting for suppressing acid production. Side-effects are mild and include diarrhea or headaches.

3. Prokinetic agents: these drugs help to empty the stomach quicker and help closing the lower esophageal sphincter (LES).

Surgical Procedures:

If treatment with lifestyles modifications, over-the-counter medications, and/or prescription medications, is unsuccessful then option for surgery can be considered. However, there is rarely a need for surgery because a high success rate for the alternative. Some people might want a permanent relief from the life long usage of drugs and discomfort.

1. Nissen Fundoplication:

Nissen fundoplication is a type of surgical procedure known as fundoplication, the standard surgical treatment for GERD. The Nissen fundoplication is performed using a laparoscope. A small incision is made in the abdomen, and a laparoscope is inserted. A small camera is also inserted from a small hole through which the surgeon can visualize the abdominal and the pelvic cavities. Then, the upper most part of the stomach is wrapped around the lower esophageal sphincter (LES). Through this procedure, LES is strengthened preventing acid reflux, as well as, repairing hiatal hernia. Laparoscopic fundoplication is s safe and effective procedure for people of all age groups, including infants. After the procedure, only a 1-3 day stay in the hospital is required and full recovery is made within 2 to 3 weeks.

2. Endoscopic Techniques:

This technique uses Bard EndoCinch system, NDO Plicator, and the Stretta system to treat chronic heartburn. All procedures require using endoscope to perform the anti-reflux operation. The EndoCinch and NDO Plicator systems strengthen the lower esophageal sphincter (LES) by stitches in to the muscle. On the other hand, the Stretta system creates small burns on the LES using electrodes. The scar tissues that are produced after the healing of these burns, is though to strengthen the muscle of lower esophageal sphincter (LES). Though, long-term effects of these techniques are yet not fully known.

Complications of these surgeries are mild, but may include dysphagia, bloating and diarrhea.

Complications of GERD:

Esophagitis; bleeding ulcers; strictures – narrowing of the esophagus lumen; Barrett’s esophagus; esophageal carcinoma

GERD may also contribute in producing or worsening asthma, chronic cough, and pulmonary fibrosis