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Acid Reflux and Gerd

Gastroesophageal reflux disease (GERD) is a chronic, common condition and more severe form of acid reflux. Gastroesophageal reflux disease (GERD) is in which the stomach contents move up into the oesophagus.

Many people experience acid reflux from time to time. However, when acid reflux happens repeatedly over time, it can cause GERD. Reflux becomes a disease when it causes frequent or severe symptoms or injury.

 CAUSES

Gastroesophageal reflux disease (GERD) occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.

GERD is caused by frequent acid reflux or also reflux of nonacidic content from the stomach.

When you swallow, a circular band of muscle around the bottom of your oesophagus (lower oesophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again.

If the sphincter does not relax as it should or it weakens, stomach acid can flow back into your oesophagus. This constant backwash of acid irritates the lining of your oesophagus, often causing it to become inflamed.

SYMPTOMS OF GERD

Different people are affected in different ways by GERD. The most common symptoms are:

SYMPTOMS in infants and children

Infants and children can experience similar symptoms of GERD, as well as:

  • Frequent small vomiting episodes.
  • Excessive crying, not wanting to eat (in babies and infants).
  • Other respiratory (breathing) difficulties.
  • Frequent sour taste of acid, especially when lying down.
  • Hoarse throat.
  • Feeling of choking that may wake the child up.
  • Bad breath.
  • Difficulty sleeping after eating, especially in infants.

 Risk factors for GERD

      Risk factors for GERD include:

  • Living with obesity
  • Pregnancy
  • Living with a connective tissue disorder
  • Smoking
  • Frequently eating large meals
  • Consistently lying down or going to sleep shortly after eating
  • Eating a lot of certain types of foods, like deep fried or tomato products
  • Drinking certain types of beverages, like soda, coffee, or alcohol
  • Using an abundance of nonsteroidal anti-inflammatory drugs (nsaids), like aspirin or ibuprofen

Alcohol and GERD

Alcohol consumption and GERD have been connected in many studies, and it seems like the more alcohol you drink, the higher the likelihood you might develop GERD.

While the connection is not crystal clear what is clear is that limiting alcohol intake, or stopping it completely, after you’ve been diagnosed, may provide some symptom relief.

DIETARY TRIGGERS FOR GERD

Some people who’ve been diagnosed with GERD find that certain foods and beverages can trigger their symptoms. While triggers can be very personal, there are a few foods that are routinely cited as more triggering than others. They include:

  • High fat foods (like fried foods and fast foods)
  • Citrus fruits and juices
  • Tomatos and tomato sauces
  • Onions
  • Mint
  • Coffee
  • Soda
  • Large meals

COMPLICATIONS

Patients with severe reflux may suffer from further complications, including:

DIAGNOSIS

After a physical examination during which you discuss your symptoms and medical history, your provider can usually identify if you have simple acid reflux (not chronic). Your doctor may begin therapy without doing diagnostic tests.

However, testing may be carried out if:

  • Your symptoms not typical of GERD
  • The severity of the reflux raises concerns about oesophageal damage
  • Symptoms do not respond to initial treatment
  • Your healthcare professional is considering anti reflux surgery

Diagnostic procedures for GERD include:

  • Upper endoscopy
  • Reflux testing (wireless pH/pH impedance)
  • Esophageal manometry
  • Barium esophagram
  • Upper gastrointestinal GI endoscopy and biopsy: Your provider pass an endoscope (a long tube with a light attached) through your mouth and throat to look at the lining of your upper GI tract (esophagus and stomach and duodenum). The provider also cuts out a small bit of tissue (biopsy) to examine for GERD or other problems.

 

  • Oesophageal pH and impedance monitoringand Bravo wireless oesophageal pH monitoring: These tests both measure the pH levels in your esophagus. Your provider inserts a thin tube through your nose or mouth into your stomach. Then you are sent home with a monitor that measures and records your pH as you go about your normal eating and sleeping. You’ll wear the esophageal pH and impedance monitor for 24 hours while the Bravo system is worn for 48 hours.

 

  • Upper GI series: X-rays of your upper GI tract show any problems related to GERD. You drink barium, a liquid that moves through your tract as the X-ray tech takes pictures.

 

  • Esophageal manometry: A manometry tests the functionality of lower esophageal sphincter and esophageal muscles to move food normally from the esophagus to the stomach. Your provider inserts a small flexible tube with sensors into your nose. These sensors measure the strength of your sphincter, muscles and spasms as you swallow.

 Treatment

Treatment approaches for GERD include:

  1. Lifestyle and dietary changes
  2. Medication
  3. Endoscopic therapy
  4. Surgery

1.Lifestyle and dietary changes:

Dietary and lifestyle changes are the first step in treating GERD. Certain foods make the reflux worse, as mentioned earlier. Avoiding such foods can alleviate your symptoms. Other lifestyle measures to reduce the GERD symptoms are:

  • Lose weight if you are overweight
  • Quit smoking
  • Do not lie down immediately after a meal
  • Elevate the level of your head when you lie down

2. Medication

If lifestyle and dietary changes do not work, your doctor may prescribe certain medications. There are two categories of medicines for reflux. One decreases the level of acid in your stomach, and one increases the level of motility (movement) in the upper gastrointestinal tract.Eg: Antacids, Histamine 2 blockers, Proton pump inhibitors, Prokinetic agents.

3. TIF and Other Endoscopic Therapy

Transoral incisionless fundoplication (TIF) is an option to treat GERD. TIF can mean a shorter treatment time, less pain and faster recovery compared to laparoscopic surgery. The procedure involves using a special TIF device to create a passageway for a flexible, tube-like imaging instrument called an endoscope. The procedure allows the physician to use preloaded tweezers and fasteners to repair or recreate the valve that serves as a natural barrier to reflux.

4. Surgery for GERD

If your symptoms did not improve with lifestyle changes or drug therapy, you may be a candidate for surgery. Some patients prefer a surgical approach as an alternative to a lifetime of taking medications. The goal of surgery for reflux disease is to strengthen the anti-reflux barrier.

 OUTLOOK

If you have GERD, your healthcare provider will work with you to develop a treatment plan that is right for you. Depending on where you are with the issue, OTC drugs, prescription meds, and even surgery are all alternatives.

Don’t let persistent heartburn keep you from enjoying life. If you feel you have GERD symptoms, get medical attention.