GERD - Gastroesophageal Reflux Disease!

GERD
In medical terms, Gastroesophageal Reflux Disease, commonly termed as GERD, is a prolonged recurrence of gastroesophageal reflux. It is a disorder in which the acid available in the stomach moves to the esophagus and retains there for a longer duration. Esophagus is a ring of muscle and is the part of the tube that connects the throat with the stomach. Gastroesophageal means something related to the esophagus and the stomach.

Reflux refers to flowing back or returning of some liquid or fluid from its expected place or position. So, GERD is defined as a condition in which the liquid (acid) flows back from the stomach to the esophagus and causes adverse effects. When the acid from the stomach reaches the esophagus, it may damage the vital tissues.

Most of us suffer from acidity often. In case an individual suffers from acidity for more than twice a week for a prolonged period, the condition may be associated with GERD. Normally, a valve, known as Lower Esophageal Sphincter (LES), is placed between stomach and esophagus, which relaxes only to swallow food, water and saliva.

This LES valve prevents the stomach juices and flowing back of acid to the esophagus and the throat, especially when we lay down on the bed. When this valve stops functioning as expected and relaxes unnecessarily, the acid from the stomach may reach the esophagus. GERD is a common disease. It is believed that almost every individual experience GERD at least once in the lifetime.

As per the reports from American College of Gastroenterology, more than 15 million individuals from America experience suffer from heartburn almost every day. This count is around 20% of the America’s population. Note that the individuals of any age group may suffer from GERD. Although GERD is mainly a digestive disorder, but it is identified that individuals suffering from Asthma are more prone to suffer from it.

The reason being, since Asthma causes the LES to relax more frequently. This might allow the stomach to reflux the digestive juices along with the acid to the esophagus. Additionally, some of the asthma medicines, like theophylline, may raise the tendency of LES reflux, which could trigger GERD.

Symptoms of GERD
The various symptoms of GERD include:

- Burning sensation in the chest and throat

-  Excessive burping

- Stomach bloating

- Observing the acid taste in the mouth while burping

- Eaten food reaching to the mouth while burping

- Difficulty in swallowing food

- Constant pain in the chest for few hours after the meals

- Chest pain while swallowing the food or water

- Excessive production of saliva in the mouth

- Constant throat soaring for several days

- Hoarseness of voice

-  Inflammation in the gums

- Cavities of teeth

- Bad breath even after proper brushing of teeth

- Difficulty in breathing

- Lack of appetite

- Vomiting or nausea

- Lump feeling in the throat

- Disturbed sleep with uneasiness in the throat

- Wheezing sound while breathing

Causes of GERD
Normally, GERD is a common problem, which may occur due to numerous reasons. However, at times it occurs due to unknown reasons. The primary probable causes of this disease are mentioned below:

- Overeating

- Lying on the bed immediately after eating

- Eating too spicy food

- Weakening of esophagus due to poor muscle control or weakness in the body

- Due to certain medication comprising antihistamine, calcium channel blocker, sedative, antidepressant, and those for the treatment of asthma

- Being overweight, which induces more pressure on the stomach and abdomen causing LES to open unexpectedly

- Pregnancy also causes more pressure on the stomach and opens LES inappropriately

- Direct and passive smoking

- Overconsumption of alcohol

- Hiatal hernia, in which the diaphragm builds pressure on the stomach

Prevention of GERD
Although you may observe GERD due to multiple reasons, there are several measures that you may take to prevent it to some extent. Some of those are discussed below:

- The patients of Asthma or those who would have suffered from GERD must quit smoking.

- Elevate or raise the head side of your bed to around 6 inches than the feet side.

-  Maintain a healthy weight. Take measures to lose weight in case it is beyond the prescribed body-mass index. The excessive fat on your belly would increase the pressure on your stomach. This would forcibly open the LES on often basis, which will then allow the acid to reach at the esophagus.

- Limit the consumption of alcohol.

- Avoid heavy meals, especially in the evening. Do not go to the bed for at least three to four hours from your dinner or any other meal.

- Limit the consumption of caffeine-based products like coffee.

- Avoid consuming the theophylline drug, if possible.

- Exercise every day. However, do not work out immediately after your meals.

- Avoid eating over-spicy and junk foods.

- Consult a good dietician and eat accordingly during the pregnancy.

- Do not wear very tight clothes near to the belly. This may again increase the pressure on your stomach and open the LES, which may then allow the acid to reach at the esophagus.

- In case you are already suffering from GERD, avoid chocolates, peppermint, and tomato.

How is it diagnosed?
GERD is a common disorder that individuals often tend to ignore. Many of them assume it as a digestion disorder. The maximum that they do is to take an over the counter antacid tablet or syrup, which would ease the symptoms for a shorter duration. However, if those recur frequently or if the symptoms persist for several days, you visit your doctor.

The physician would assess the symptoms and may recommend the patient to visit the gastroenterologist for specialized treatment and investigations. One or more of the following investigations may be prescribed for the patient to confirm the occurrence of GERD:

- Esophageal pH and Impedance Monitoring: This test identifies the quantity of the acid content available in the esophagus in different states of the patient’s body, like before and after eating or sleeping.

- Upper Gastrointestinal or GI Endoscope: In this test, a camera attached with a tube is passed through the food pipe of the body. This camera captures pictures within the food pipe and the esophagus. The same process may also be used to extract a smaller piece of tissue, which would be sent to the laboratory for investigations.

- Upper Gastrointestinal or GI Series: In this test, X-ray captures pictures near to the esophagus that identify the causes of GERD.

- Esophageal Manometry: This test is based on measuring the contraction of muscles in the esophagus while swallowing food or water. It identifies the strength of the LES. In case it is found to be weaker, the individual is more likely to suffer from GERD.

- Bravo Wireless Esophageal pH Monitoring: This test involves attaching a small capsule to the esophagus for near to two days or 48 hours. This capsule measures the acidity level at the esophagus caused by the acid reflux from the stomach. In case the acidity near to the esophagus is higher continually for around two days, the individual is suffering from GERD.

Treatment of GERD
If GERD is confirmed by the doctors once after assessing the reports of the prescribed investigations, they would treat the patient based on the severity of symptoms. In normal cases, those are treated through certain course of medication. Many of these medicines focus on reducing the acid content in the stomach of the patient, which may relieve the patients from the symptoms of GERD.

Some of the common medicines used for the treatment of GERD are mentioned below:

- Proton Pump Inhibitor: These drugs are formulized to reduce the acid content in the stomach. The least acid is available in the stomach, lesser will be the chances to get it refluxed to the esophagus, which may cause GERD.

- H2 Blocker: This is another class of drugs, which would reduce the production of acid in the stomach.

- Antacid: Antacids are very common and over the counter medicines, which act by reversing the impact of acid in the stomach through multiple alkaline ingredients. Those are quite useful in the acidity and heartburn. However, those may cause multiple side effects such as constipation and diarrhea.

- Prokinetic: This medicine stimulates the digestion process of the body, which would empty the stomach faster than normal. Once the stomach is empty, the acid could not reflux to the upper side and reach the esophagus, which would avoid GERD. Since these medicines enhances digestion in the patient’s body, the individual may suffer from diarrhea. Those also cause other side effects such as anxiety and nausea.

- Erythromycin: These are the antibiotics, which treat the bacterial infection causing indigestion. Once the infection is treated, the acid formation in the stomach of the patient will be normalized, and GERD may be avoided.

In some severe cases, the patient would not be relived from the symptoms of GERD by changing the lifestyle and following the course of prescribed medication. In such cases, the gastroenterologist might recommend the patient to undergo a surgical treatment. The surgeries could be of following types:

- Fundoplication: In this process, the surgeon stitches some part of the stomach’s top near to the esophagus. This minimizes the passage between the stomach and esophagus, which reduces the chances of acid reflux. In most of the cases, this process helps in reducing the symptoms caused by GERD.

- Endoscopic Surgery: This process involves endoscopic stitching of the LES, which tightens the muscles involved in closing the valve near to the esophagus. The surgery is carried out using radiofrequencies, which produce heat for creating a burning effect for tightening of the LES muscles.

Complications of GERD
Most of the individuals suffering from heartburn take it very lightly. They often follow some home remedies or consume the over the counter medicines to get relieved from it. However, some patients of prolonged GERD may be at risk of complications. Some of such major complications are discussed below:

- Oesophageal Ulcers: This is the condition in which the acid floating from the stomach to the esophagus damages the lining of the esophagus. This further causes formation of ulcers, which may bleed and cause pain. The patients may even find it very difficult to swallow their chewed food because of the formed ulcers.

- Scarred and Narrowed Esophagus: In case a patient suffers from GERD for a long duration, the continual impairment of the esophagus caused by the refluxed acid may narrow it. This will further make very difficult for the patient to swallow anything. In such a case, a small balloon looking device is used for the widening of esophagus to ease the condition.

- Barrett's Esophagus: In case GERD is repeated frequently and not treated well, the cells in the LES lining are impacted. There is a little risk that the patient’s suffering from this condition or Barrett's Esophagus may suffer from oesophageal cancer due to the impaired cells. Around 10% of the GERD patients attain the Barrett's Esophagus condition. Further, 5 – 10% of the Barrett's Esophagus patients may suffer from the oesophageal cancer.

Myths of GERD
Myth #1: The only cause of GERD is eating spicy food.

There are lots of reasons causing GERD. Eating spicy food may be one of those.

Myth #2: Heartburn is a normal condition, which would heal either by its own or consuming the antacids.

Heartburn could be a symptom of GERD. If not treated on time, it may cause complications to the patient suffering from it.

Myth #3: Acidity is always caused by indigestion.

Acidity or heartburn could be caused by multiple reasons other than indigestion. It could also be a symptom of GERD, which must be treated by the doctor on time.

Myth #4: GERD may only affect kids and aged people

GERD can impact people of any age.

Myth #5: GERD is more likely to take place in the winters.

The patients may suffer from the symptoms of GERD in any season or month.

Myth #6: Healthy people with a robust immune system could not suffer from GERD.

Healthy immune system is not an important criterion for preventing the development of GERD in the body. However, those individuals whose esophagus muscles are weaker, are more prone to develop this disease.