Gastroesophageal Reflux Disease (GERD): Symptoms, Causes, Treatment, Surgery, Cost And Diet

Gastroesophageal reflux or GERD disease is a kind of disorder which affects the lower esophagal sphincter (LES), which is a muscle ring that exists between esophagus and stomach. Gastroesophageal reflux can cause heart burns and acid indigestion wherein the stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus).

It is believed that people with Gastroesophageal reflux can be because of a medical condition called hiatal hernia. Balanced and proper diet and lifestyle changes are mandatory to get rid of Gastroesophageal reflux. In severe cases, people may require medication or surgery. Gastroesophageal reflux is a medical condition in which contents of the stomach is returned to the oesophagus causing indigestion and heartburn.

If you are prone to acid reflux, then you may experience:

• Difficulty in swallowing
• A sensation of burning in chest, which worsen at night after eating
• Chest pain
• Food or sour liquid regurgitation
• A sensation of a lump in the throat

If you are prone to acid reflux during the night, then you may experience:

• A severe cough
• Worsening asthma
• Sleep disruption
• Laryngitis

The cause behind Gastroesophageal reflux can be due to a frequent acid reflux. What happens when you swallow food is that a circular band of muscles located in the bottom of esophagus relaxes and the food and liquids flow into your stomach. The sphincter again closes. If the sphincter relaxes or weakens abnormally, the contents return backs to the esophagus.

If this happens repeatedly, the acidic contents can irritate your esophagus making it inflamed. Conditions like obesity, pregnancy ,delayed stomach empting all can cause the chances of Gastroesophageal reflux in a person. Acid reflux can also be caused by smoking, eating large meals or late night meals, eating fatty fried foods or triggers, drinking alcohol or coffee and aspirin medications.

The treatment begins by diagnosing the Gastroesophageal reflux in a person. The diagnosis for GERD is done through the following:

1. Upper endoscopy: A thin flexible tube fitted with camera and light known as an endoscope is inserted down the throat. The inside of esophagus and stomach is then examined. If the reflux is present, then the test results will be normal. Endoscopy can also detect esophagus inflammation and other complications. This is also used to check for Barrett's esophagus using a sample of tissues (biopsy)

2. Ambulatory acid (pH) probe test: This is to identify for how long acids in the stomach are regurgitating by placing a monitor in the esophagus. A computer is connected with a strap to wear around your waist and strap around your shoulder. The monitor is a thin, flexible tube that is taken to examine esophagus through your nose. Often a clip is placed in your esophagus which gets passed through stool after two days.

3. Esophageal manometry: the rhythmic muscle contractions when you swallow in the esophagus is measured. The force and coordination during exertion of muscles are measured through esophageal manometry.

4. X-ray: X-ray of the upper digestive system: you will be asked to drink a chalky liquid which fills inside the digestive lining track and X rays are taken after drinking. The coating of the liquid allows the surgeon to examine the esophagus, stomach and upper part of the intestine. The narrowing of the esophagus can be examined by swallowing a barium pill which will interfere with swallowing.

After the diagnosis, the treatment plan is chosen based on the condition of the patient.

Gastroesophageal Reflux treatment:

1. Medication:

• Antacids which can neutralize stomach acid: Mylanta, Rolaids, and Tums are antacids may provide instant relief. This cannot heal the inflammation of esophagus which is being damaged by acids in the stomach. Side effects of antacids overdose are diarrhoea and kidney problems.
• Medications which resist acid production:They are known as H-2-receptor blockers. Cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (AXID AR) and ranitidine (Zantac). They are not as much action as antacids but provide long relief and can reduce the acid production up to 12 hours in the stomach.
• Esophagus healing and acid production blockers: They are named as proton pump inhibitors, they stand somewhere between acid blockers and H-2 receptor blockers. They help to in healing of damaged tissue associated with the esophagus.
• H-2 receptor blockers: The prescribed H-2 receptor blockers include famotidine, nizatidine, and ranitidine commonly known as Pepcid and Zantac. Some of them are lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC).
• Proton pump inhibitors : The common medications are esomeprazole(Nexium), omeprazole(Prilosec, Zegerid), pantoprazole (Protonix), lansoprazole(Prevacid), dexlansoprazole(dexilant) and rabeprazole(Aciphex). Baclofen can decrease the relaxation frequency of lower esophageal sphincter and helps in healing from GERD

2. Surgery:

When the symptoms are severe and when medications are not able to provide proper relief to the patient then, surgery may have opted accordingly. Surgery options available are as follows:

• Fundoplication:the reflux is prevented by tightening the muscle around the lower esophageal sphincter by wrapping the top of the stomach. It is a minimally invasive procedure. The stomach wrapping can be sometimes partial or complete.
• LINX device: The junction of the stomach and esophagus is wrapped with tiny magnetic beads. A sense of magnetic attraction between the beads is strong enough to close the reflux by restricting the food to return back to the esophagus. This is a minimally invasive implantation surgery.

The medicines used for the treatment of the Gastroesophageal reflux disease are safe if consumed in the right quantity.

• The medications if used excessively can lead to diarrhea, nausea, fatigue, headache, and vitamin B 12 deficiency.
• Long-term use of acid blockers and H-2 receptor blockers may trigger vitamin B-12 deficiency and bone fractures.
• Proton pump inhibitors have good tolerance but they can cause diarrhea, nausea, headache and vitamin B-12 deficiency.
• Excessive usage may lead to hip fracture. Excessive use of Baclofen can lead to nausea and fatigue.

There may be times when GERD can cause some serious complications in a patient. as a result of too much acid in the stomach, a person might suffer from esophagitis. The condition of esophagitis may lead to bleeding of the oesophagus or ulcers. There may be chronic scarring due to the narrowing of the esophagus. A condition known as Barrett’s esophagus may also be developed in people suffering from the condition of GERD. It can also lead to esophageal cancer.

The recovery time may vary from person to person situation and medication condition. The severity of symptoms and indigestion can be prevented over a short course of time of few days. If adopted lifestyle changes and dietary changes, the results can be somewhat beneficial and the recovery may be soon with medication which can be of few days and weeks. Surgery may take 8 to 10 weeks to get cured and start a normal routine.

It is possible to prevent the occurrence of GERD if a person makes certain lifestyle changes in his/her life. Given below are some of the tips which might help in the prevention of the GERD.

• Avoid the foods which are responsible for causing acid reflux like spicy food, fatty food, chocolate, mints, etc.
• If a person is obese then he/she must exercise and try to lose some weight.
• Rather than eating one large meal, a person should divide the meal into smaller ones so that less pressure is exerted on LES.
• The head of the bed must be elevated by 6 to 8 inches as this leads to gravity help in keeping the gastric acid down in the stomach.
• If a person is in a habit of smoking then he/she must quit smoking.
• The consumption of alcohol must be restricted especially if a person is a heavy drinker.
• Attempt a without gluten diet may avoid the event of GERD.
• An individual ought not rests in the wake of eating.

The treatment is reasonable and the medications would cost you around Rs 100 –Rs 300 on an average. However, depending upon the place and clinic the surgery can cost you around Rs 50,000 to Rs 2,00,000.

The medications and surgery often give good results for treating the Gastroesophageal reflux disease. It can be quoted as a semi-permanent solution as one needs to adopt lifestyle changes and dietary habits to make them better and thus have a permanent solution. But the acid refluxes can occur again due to bad eating habits, thus a properly balanced diet and a perfect lifestyle are essential for a permanent solution.

The foods which must be avoided if a person is suffering from the condition of GERD are given below:

• High-Fat meals and Fried foods: Emptying of the stomach is delayed if a person consumes fatty foods as they lower the pressure on the LES. Thus results in an increase in the symptoms of acid reflux. To prevent acid reflux a person needs to reduce the intake of the fats. Some of the foods which must be avoided are ice cream, French fries, deep-fried onion rings, butter, high fat cut meat, potato chips, etc.
• Spicy foods: Some of the studies have indicated that eating food that is full of spices can lead to pain in the abdomen and burning sensations. Thus, if a person is suffering from the condition of GERD consumes spicy food then his/her symptoms might be aggravated.
• Beverages: There are some drinks as well which trigger the symptoms of GERD in a person. These drinks include carbonated beverages, citrus and tomato juice, coffee, tea, and alcohol.
• Fruits and vegetables: Some of the fruits and vegetables which must be avoided are tomato, pineapple, grapes, limes, lemons, garlic, and onions.

The home remedies for the Gastroesophageal reflux disease are as follows:

• Apple cider vinegar, lemon juice, baking soda can be tried to treat this condition.
• Place a few thin slices of ginger root tea in a mug and steep in hot water for 10 – 20 minutes. Then drink. It can help calm an upset tummy or stop it from even occurring.
• Ayurveda and homoeopathy are also effective in treating this condition.