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Friday, June 23, 2017

GERD (Gastroesophageal reflux disease) by Dr C Vasudev, Consultant Gasteroenterologist at SevenHills Hospital Mumbai.


Reflux Oesophagitis(GERD) is a very common disorder occurring in at least 10% of the general population. Reflux is leaking of acid into the food pipe. Oesophagitis is inflammation of lining of food pipe. It is one of the common modern day maladies which is contributed by excess stress levels, smoking, alcohol intake and obesity. If you experience symptoms like burning sensation behind your mid chest, have sour food coming into mouth, diurnal change in voice (voice becomes better by evening), wake up at night with acidity or burning in the chest, having to consume antacids on regular basis or drink milk or excess water for acidity relief then you may be suffering from this illness commonly termed as GERD (Gastroesophageal reflux disease).
Gastroesophageal reflux disease is caused by reflux of the contents of the stomach mainly acid into the food pipe (Oesophagus) due to malfunctioning of valve at the junction of food pipe and stomach (Loose GE Valve or loose lower oesophageal sphincter). The inner lining of the stomach is resistant to damage by acid produced in the stomach whereas the same acid when it refluxes into the food pipe causes damage to the inner lining since the food pipe is very sensitive. The most common symptom is heartburn.
Other complaints include acid taste in mouth, excessive belching, indigestion, burning pain while swallowing hot drinks, chronic cough (especially at night), gum problems, bad breath, repeated dental issues, change in voice (hoarseness), feeling of a lump in throat and asthma.
Tests which are done to confirm the condition include Gastroscopy and Impedance pHmetry. The lower part of the oesophagus looks red, inflamed and ulcerated. Some patients may not show any findings on endoscopy which is labeled as ENRD (Endoscopy-negative reflux disease). They are the ones who are very sensitive to small amounts of acid reflux but have little or no damage found on endoscopy. The best way to detect these ENRD patients whether they suffer from reflux Oesophagitis is by doing an Impedance pHmetry. So, what helps these patients? Certainly, lifestyle changes go a long way in helping to avoid from regular medication to relieve the symptoms. These lifestyle modifications include eating food in small portions and more frequently than the regular three large volume meals, avoiding spicy stuff, citrus fruits, peppermint, tomatoes, chocolate, spicy foods, hot drinks, coffee and alcoholic drinks, avoiding water intake along with meals, using two pillows to raise head end while sleeping, early dinner and gap of 3-4 hours between dinner and bedtime thereby ensuring a dry and empty stomach while going to bed.

Losing weight releases the extra pressure over the stomach which gets increased when patients are obese. Bicycling is a good form of exercise for patients with Reflux Oesophagitis. The only medications which help these patients are proton pump inhibitors (PPI) and H2 receptor antagonists (ACID SUPPRESSING AGENTS). PPIs include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. H2 blockers include famotidine and ranitidine. All PPI’s are equally effective in suppressing the acid production in the stomach. H2 receptor antagonists are less effective than PPI’s in general in suppressing acid production and the symptoms in these patients. The surgical operation can 'tighten' the lower oesophagus to prevent acid leaking up from the stomach (Fundoplication). It can be done laparoscopically (’keyhole’ surgery called Laparoscopic Fundoplication). Surgery may be an option for some people whose quality of life remains significantly affected by their condition and where medications are not working well or for patients who do not wish to continue them long-term. Surgery has its own complications so the patients are to be carefully chosen for its success. The complications of not treating the symptoms effectively include Oesophagitis, Lower oesophageal stricture(Peptic stricture) leading onto difficulty in swallowing, Barrett’s Oesophagus( a Pre-cancerous condition), Oesophageal cancer (Food pipe cancer). 

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