Gastroesophageal reflux disease: Causes, Symptoms, Treatment, and Cost

Inflammation and irritation of the esophagus are symptoms of gastroesophageal reflux disease (GERD), a chronic digestive ailment caused by the passage of stomach acid and digestive fluids back into the stomach.

Gastroesophageal reflux disease (GERD) comes in two forms:

• Non-erosive reflux disease (NERD): This type of GERD is characterized by typical symptoms of GERD, such as heartburn and regurgitation, but there is no evidence of esophageal inflammation or damage on endoscopy.
• Erosive reflux disease (ERD): This type of GERD is characterized by the presence of esophageal inflammation or damage on endoscopy. ERD can lead to complications such as esophageal strictures, Barrett's oesophagus, and esophageal cancer.

Several variables may contribute to the development of GERD, although the precise reason is not entirely known. They include:

• Hiatal hernia: This happens when a section of the stomach protrudes into the chest cavity via the diaphragm. Due to the weakened LES caused by hiatal hernias, it may be simpler for stomach acid to flow back up into the oesophagus.
• Abnormalities in the LES: Sometimes the LES may not function properly due to congenital defects or damage from surgery, which can lead to reflux.
• Obesity: Overweight individuals may have pressure on the stomach, weakened LES, and reflux as a result. Pregnancy: The LES may loosen due to hormonal changes during pregnancy, which might result in reflux.
• Smoking: Cigarette smoke can irritate the esophagus and weaken the LES.
• Certain foods and drinks: Foods that are high in fat, spice, or acidity, as well as alcohol, coffee, and chocolate, can all trigger reflux in some people.
• Medications: Certain drugs, including those for anxiety, high blood pressure, and asthma, might relax the LES and result in reflux.
• Certain medical conditions: People with certain medical conditions, such as scleroderma, a connective tissue disorder, or a condition called gastroparesis, in which the stomach takes too long to empty, may be at higher risk of developing GERD.

Symptoms of gastroesophageal reflux disease (GERD) include:

• Heartburn: The sensation of burning in the chest after eating.
• Acid regurgitation: The feeling of stomach acid rising into the mouth or throat.
• Difficulty swallowing: An impression that food is lodged in the chest or neck.
• Hoarseness or sore throat: A persistent cough or clearing of the throat.
• Nausea and vomiting: the sensation of being queasy in the stomach.
• Chest pain: A behind-the-breast discomfort that is piercing and searing.
• Difficulty sleeping: Insomnia or waking up frequently at night due to discomfort.
• Bad breath: A bad aftertaste in the mouth, such as sourness.
• Bloating and gas: An abdominal sense of fullness or pain.
• Tooth erosion: Acid reflux can cause erosion of tooth enamel over time.

Gastroesophageal reflux can be prevented by adopting the following measures:

• Lifestyle changes: Avoiding triggers such as spicy and fatty foods, alcohol, and caffeine and quitting smoking. Eating smaller, more frequent meals and losing weight may also be beneficial.
• Avoid lying down after meals: Before going to bed, it is advised to wait for at least 3 to 4 hours after eating. Elevating the head of the bed: Blocks placed beneath the head end of the bed may stop stomach acid from returning to the esophagus.
• Chewing gum: Gum chewing increases saliva production, which may assist in reducing stomach acid. Managing stress: Finding strategies to handle stress, such as meditation or counseling, may be useful since stress may cause GERD symptoms.
• Drinking plenty of water: Water consumption might lessen the effects of stomach acids and symptoms.
• Avoiding tight clothing: Your stomach may feel compressed in tight clothing, which may exacerbate GERD symptoms.
• Regular exercise: Daily exercise helps minimize GERD symptoms by enhancing digestion and maintaining a healthy weight.

Gastroesophageal reflux can be diagnosed by the following test:

• Esophageal pH monitoring test: A test that measures the acidity levels in the oesophagus to determine if acid reflux is occurring.
• Upper endoscopy: A procedure where a thin, flexible tube with a camera is inserted through the mouth to examine the oesophagus and stomach for signs of damage from acid reflux.
• Barium swallow test: A test where a patient drinks a liquid containing barium, which allows for X-rays to be taken of the oesophagus and stomach to detect abnormalities or obstructions.
• Manometry: A test that measures the pressure and muscle contractions in the oesophagus to determine if they are functioning properly.
• Esophageal impedance testing: A test that measures the movement of liquid and gas in the oesophagus to detect acid reflux and other abnormalities.

The following are potential side effects of gastroesophageal reflux disease:

• Esophagitis may result from gastroesophageal reflux disease (GERD), which can irritate and inflame the oesophagus.
• Barrett's oesophagus, a disorder in which the cells lining the lower oesophagus become aberrant and raise the risk of esophageal cancer, may develop as a result of chronic GERD.
• GERD can also cause respiratory symptoms, such as coughing and wheezing, due to the inhalation of stomach acid into the lungs.
• Due to oral exposure to stomach acid, people with GERD may develop dental issues, such as tooth enamel degradation.
• Chronic GERD can lead to the development of strictures, or narrowing of the oesophagus, which can cause difficulty swallowing and food impaction.
• In extreme situations, Barrett's oesophagus, a precancerous disease that may raise the chance of developing esophageal cancer, can develop as a result of GERD.

These are the basic home remedies to treat Gastroesophageal reflux:

• Amla (Indian Gooseberry) juice helps reduce acidity and improves digestion.
• Triphala powder (a mixture of three fruits) can be taken with water after meals to improve digestion and reduce acid reflux.
• Licorice root (Yashtimadhu) can be chewed or taken as a tea to soothe inflammation in the digestive tract.
• Digestion may be improved and acid reflux symptoms can be lessened with ginger tea or capsules.
• Ayurvedic herbs like Shankhapushpi, Brahmi, and Ashwagandha can be taken to reduce stress and anxiety, which can aggravate acid reflux symptoms.
• Spend at least 30 minutes erect after eating.
• Instead of eating big meals, eat smaller, more regular meals.
• Use a solution of apple cider vinegar and water before meals to reduce acid reflux.
• Baking soda can be added to water and drunk to neutralize the acid in the stomach.
• After meals, fennel seeds may be eaten to ease the symptoms of acid reflux.
• After eating, avoid lying down.
• To lessen acid reflux symptoms at night, raise the head of the bed.

This food should be taken for Gastroesophageal reflux disease:

• It is advised to eat lean proteins like chicken, fish, and turkey.
• Broccoli, cauliflower, green beans, and leafy greens are examples of healthy vegetables.
• Fruits such as apples, bananas, melons, and berries are safe to eat.
• Muesli, brown rice, and quinoa are examples of healthy whole grains.
• You can have low-fat dairy items such as skim milk, yogurt, and cheese.
• You may have nuts and seeds in moderation.

The following items have to be avoided if you have GERD:

• Citrus fruits: Oranges, lemons, limes, grapefruits, and other citrus fruits may raise stomach acid and cause heartburn.
• Tomatoes: Tomato-based products such as ketchup, pasta sauce, and soups should be avoided as they are also highly acidic.
• Chocolate: Caffeine and theobromine, which are found in chocolate, may loosen the lower esophageal sphincter (LES) and let stomach acid flow back into the esophagus.
• Alcohol: Alcohol may aggravate the symptoms of GERD by irritating the esophageal lining and raising stomach acid production.
• Carbonated beverages: Bloating and increased pressure on the LES from carbonated beverages may cause stomach acid to leak back into the esophagus.
• Fried and fatty foods: High-fat meals take longer to digest and can cause the LES to relax, leading to acid reflux.
• Spicy foods: Inflammation of the esophagus and an increase in acid production from spicy meals may result in heartburn and other GERD symptoms.
• Onions and garlic: These foods are known to cause heartburn and should be avoided or consumed in moderation.
• Mint: Peppermint, spearmint, and other mint-flavored foods or beverages can relax the LES and allow acid to flow back into the esophagus.
• Coffee: Caffeine, a component of coffee, may cause GERD symptoms by relaxing the LES and increasing the production of stomach acid.

The treatment of Gastroesophageal reflux are :

• Endoscopic procedures: Endoscopic procedures such as radiofrequency ablation (RFA) and transoral incisionless fundoplication (TIF) are minimally invasive procedures that can help improve the symptoms of GERD by strengthening the LES.
• Alternative therapies: Alternative treatments for GERD include acupuncture, herbal medicines, and relaxation methods for certain sufferers. Before attempting any alternative treatments, it's crucial to speak with your doctor since some of them can interact negatively with your prescription drugs or make your symptoms worse.
• Fundoplication: This is the most common surgical treatment for GERD. To tighten the valve between them and stop acid from coming back up into the esophagus, the upper half of the stomach is wrapped around the lower part of the oesophagus during this treatment.
• LINX device: This is a newer treatment option that involves implanting a small, flexible band of magnetic titanium beads around the lower esophageal sphincter (LES). This band helps to keep the LES closed, preventing acid reflux.
• Endoscopic treatments: In some cases, GERD can be treated using endoscopic techniques. This may involve the use of devices like the Stretta or the EsophyX, which use radiofrequency or suction to reshape the LES and improve its function.
• Esophagectomy: Surgery to remove all or part of the oesophagus may be used to treat GERD in very rare circumstances. Surgery is normally only carried out if all other therapeutic options have been exhausted and if long-term GERD increases the risk of developing cancer.

A doctor who specializes in treating digestive issues like gastroesophageal reflux disease is a gastroenterologist (GERD). For the diagnosis and treatment of GERD, a visit to a gastroenterologist is advised. However, primary care physicians, internists, and family medicine physicians may also be able to provide initial evaluation and management of GERD.

Here is a list of some of the commonly used classes of medications for the treatment of gastroesophageal reflux disease (GERD):

• Proton pump inhibitors (PPIs): PPIs are the most potent drugs for suppressing gastric acid secretion. They function by preventing the enzyme that causes stomach acid to be produced. Omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole are a few examples of PPIs (Prevacid).
• H2 receptor antagonists: H2 receptor antagonists are a type of medication that blocks the histamine receptors in the stomach, which reduces the amount of acid produced. Examples of H2 receptor antagonists include ranitidine (Zantac), famotidine (Pepcid), and cimetidine (Tagamet).
• Antacids: An anti-acid drug neutralises stomach acid. They work quickly and are often used as a short-term treatment for GERD symptoms. Examples of antacids include calcium carbonate (Tums), magnesium hydroxide (Milk of Magnesia), and aluminium hydroxide (Amphojel).
• Prokinetic agents: Prokinetic agents are medications that improve gastrointestinal motility, which can help reduce reflux. Examples of prokinetic agents include metoclopramide (Reglan) and domperidone (Motilium).
• Alginate-based medications: Alginate-based medications are a type of medication that forms a protective barrier on top of the stomach contents to prevent reflux. Examples of alginate-based medications include Gaviscon.

The length of time it takes to recover from gastroesophageal reflux disease depends on how severe the problem is and how it is being treated.
In most cases, symptoms can be relieved within a few weeks of starting treatment, including lifestyle modifications and medications.
The total remission of symptoms, however, can take many months in more severe situations.

The results of surgery for gastroesophageal reflux disease (GERD) can vary, but they can be long-lasting or even permanent for some patients. However, lifestyle changes may be necessary to prevent the recurrence of symptoms. It's crucial to go through the expected results and outcomes with a healthcare professional.

Here is a list of some of the commonly used classes of medications for the treatment of gastroesophageal reflux disease (GERD):

• Proton pump inhibitors (PPIs): PPIs are the most potent drugs for suppressing gastric acid secretion. They function by preventing the enzyme that causes stomach acid to be produced. Omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole are a few examples of PPIs (Prevacid).
• H2 receptor antagonists: H2 receptor antagonists are a type of medication that blocks the histamine receptors in the stomach, which reduces the amount of acid produced. Examples of H2 receptor antagonists include ranitidine (Zantac), famotidine (Pepcid), and cimetidine (Tagamet).
• Antacids: An anti-acid drug neutralises stomach acid. They work quickly and are often used as a short-term treatment for GERD symptoms. Examples of antacids include calcium carbonate (Tums), magnesium hydroxide (Milk of Magnesia), and aluminium hydroxide (Amphojel).
• Prokinetic agents: Prokinetic agents are medications that improve gastrointestinal motility, which can help reduce reflux. Examples of prokinetic agents include metoclopramide (Reglan) and domperidone (Motilium).
• Alginate-based medications: Alginate-based medications are a type of medication that forms a protective barrier on top of the stomach contents to prevent reflux. Examples of alginate-based medications include Gaviscon.

Here are some estimated costs of common GERD treatments in India:

• Medications: The cost of medications for GERD in India can range from INR 200 to INR 1500 per month depending on the type of medication and brand.
• Endoscopy: The cost of an endoscopy procedure to diagnose GERD can range from INR 3500 to INR 8000.
• Surgery: The cost of anti-reflux surgery (Nissen fundoplication) for GERD in India can range from INR 1,50,000 to INR 3,00,000.
• Esophageal pH monitoring: The cost of esophageal pH monitoring to evaluate the severity of GERD can range from INR 10,000 to INR 20,000.

Here are some of the potential side effects of gastroesophageal reflux disease (GERD) treatments:

• Proton pump inhibitors (PPIs): Common side effects of PPIs include headache, diarrhea, constipation, abdominal pain, and nausea. In addition to raising the risk of bone fractures and vitamin B12 insufficiency, prolonged PPI usage may also do so.
• H2 receptor antagonists: Side effects of H2 receptor antagonists may include headache, dizziness, diarrhoea, constipation, and nausea. In rare cases, H2 receptor antagonists may cause blood disorders or liver problems.
• Antacids: Antacids may cause constipation, diarrhoea, and abdominal discomfort. High doses of antacids can also lead to electrolyte imbalances and kidney problems.
• Prokinetic agents: Prokinetic medications have been linked to gastrointestinal adverse effects such as diarrhoea, nausea, and cramps. In rare cases, prokinetic agents may also cause movement disorders or neurological side effects.
• Surgery: Surgery for GERD carries risks such as infection, bleeding, and complications related to anaesthesia.