Gastro-Oesophageal Reflux Disease (GERD)- diagnosis and treatment

Gastro oesophageal reflux (GERD) is not very uncommon entity and many times this condition is termed as hyper acidity or, heartburn and may be confused with gastric ulcers and other conditions.

Contents of the stomach are highly acidic due to the secretion of hydrochloric acid. If they happen to regurgitate into the oesophagus, they irritate the lining of the latter and cause oesophagitis and ulceration. Normally the junction between the oesophagus and stomach remains closed due to the action of a sphincter, a ring of muscle tissue, which opens only to allow the food and drink to pass from the oesophagus into the stomach. In some persons or, physiologically during pregnancy
this sphincter may be weak and a backflow of fluids occur in the oesophagus and causes the symptoms.

There are various factors which increases this reflux or, back flow in susceptible persons:


Over-eating and make the stomach full up to brim. Bending forward after taking a full meal. Going to bed just after food. Wearing tight belts, smoking, old age, some drugs like Calcium antagonists (used for angina and high blood pressure) such as Diltiazem, Amlodiphine.


What are the symptoms of gastro oesophageal reflux



Heartburn is the constant symptom. Acid retching, dyspepsia is also quiet common. Oesophageal ulcer may bleed; vomiting of blood may occur. Difficulty of deglutition may appear after the formation of ulcers in the oesophagus. Cancer can form on the injured mucous membrane.

Endoscopy and barium swallow X-rays may be helpful in diagnosis.


Treatment of gastro oesophageal reflux disease (GERD):


Mild and uncomplicated cases and the event seen during pregnancy is relieved by the conservative measures like weight reduction, sleeping with the upper part of the body raised at an angle of about 30°-40°, light early dinner; avoid high fibre diet at night, i.e. eat rice in place of wheat. Do not use tight belt for your pants; suspenders are more suitable. Avoid bending forward particularly after meals. Avoid smoking, alcohol and excessive chocolate and coffee. Avoid calcium antagonist (Amlodipine) at night. Antacids, acid reducing drugs like Ranitidine or Famotidine, omeprazole, pantoprazole etc. are also helpful. Drugs which improves and regularize motility of the GI tract are also prescribed.

In intractable cases or, when there is complication surgical correction may be necessary. The procedure is known as fundoplication. Here the portion of the stomach near to the oesophageal sphincter is plicated to produce a pressure on the sphincter and thereby reducing the backflow.
80% of the patients with GERD also suffer from “Hiatus Hernia” an unusual gap in the diaphragm, which separates thoracic cavity with the abdomen. This rent is also repaired along with fundoplication. This operation is best done by laparoscopy by experts. Otherwise it is also done by opening the abdominal cavity or, the thorax depending on the situation.

This article is also published in India Study Channel