Gastroesophageal Reflux Disease
Understanding Gastroesophageal reflux
Gastroesophageal reflux is characterized by regurgitation of acidic contents of the esophagus. The risk of acid reflux increases in the presence of a hiatus hernia. Hiatus hernia occurs commonly in obese individuals and in those who are over age 50. Pregnancy may also raise the risk of development of hiatus hernia.
Symptoms of Gastroesopheal reflux
Some of the other less common symptoms of GERD are :
- Pain in stomach/upper abdomen
- Pain in chest, that is non burning in nature
- Swallowing difficulty.
- Pain during swallowing.
- Presence of laryngitis/hoarseness in throat on a persistent basis
- Presence of persistent sore throat
- Presence of chronic cough or beginning of asthma or presence of symptoms of asthma only at night
- Presence of regurgitation of fluids and foods in the throat
- Sensation of a lump present in the throat
- Dental disease that is deteriorating progressively
- Presence of pneumonia on a recurrent basis
- Presence of chronic sinusitis
- Presence of a choking sensation upon waking
How is GERD diagnosed ?
The diagnosis of GERD is usually made on the basis of the presence of symptoms and how the patient responds to treatment. Specific tests to diagnose GERD may be required in cases where there is unclear diagnosis or in cases where serious signs and symptoms are present.
Endoscopy :
An upper endoscopy is a technique where a small flexible tube is inserted into the esophagus, stomach and small intestine. A light source and a camera are attached to the tube and magnified images of the internal structures are displayed on a monitor. With the help of upper endoscopy, the lining of these structures is examined for any damage.
24-hour esophageal pH study :
The most direct way to measure how many times reflux is occurring during a 24 hour period is 24-hour esophageal pH study. During this test a thin tube that is connected to a small device that measures the amount of acid reaching the esophagus, is inserted via the nose into the esophagus. This tube is then left to stay in the esophagus for duration of 24 hours. During this time a diary of symptoms has to be maintained by the patient. The data obtained during the study is analyzed and the frequency of reflux is determined along with the relationship between reflux of acid and appearance of symptoms.
Esophageal manometry :
In this procedure a tube is swallowed, which measures the esophageal contractions. This helps to determine the functioning of the LES.
Complications of GERD
Usually patients suffering from GERD do not develop serious complications; however, the following complications may arise with severe disease.
Ulcers :
Ulcers can form in the lining of the esophagus due to the corrosion and burning by the stomach acid and may be complicated by bleeding in some cases.
Esophageal stricture :
Corrosion and damage of the esophageal lining from the stomach acid can ultimately lead to the formation of scar and narrowing of the esophagus, leading to esophageal blockage or stricture.
Problems in the lung and throat :
Acid may get refluxed into the throat leading to inflamed vocal cords, and symptoms of persistent sore throat and hoarseness of voice. The acid may get aspirated into the lungs leading to aspiration pneumonia or symptoms of asthma :
- Barrett’s esophagus
- Esophageal cancer
- Treatment of GERD
The treatment and management of GERD depends upon the severity of the disease.
Treatment for mild symptoms of GERD :
To treat mild symptoms of GERD, dietary/lifestyle modifications and non prescription drugs such as antacids and histamine antagonists are recommended. Lifestyle modifications: Weight loss and elevation of the head of the bed has been found useful in some patients. Other lifestyle modifications include: Avoiding eating foods that induce reflux Quitting smoking Avoiding eating large meals and at late hours Avoiding wearing tight fitting clothes Chewing gum or using oral lozenges
Treatment for Moderate to severe symptoms of acid reflux :
Patients who have moderate to severe symptoms of acid reflux or who develop complications or who have mild reflux symptoms but they have not responded to lifestyle and dietary modifications and OTC medications described above are recommended prescription medications. Majority of such patients are treated using a proton pump inhibitor.