Understanding GERD

Gastroesophageal Reflux Disease (GERD) is a long-term condition characterised by the backward flow of stomach acid into the oesophagus, leading to irritation and inflammation.

The primary cause of GERD is the weakening of the lower oesophageal sphincter (LES), a muscular ring that functions as a barrier between the oesophagus and the stomach. Under normal circumstances, the LES opens to allow food to enter the stomach and closes to prevent the reflux of food and stomach acid. In GERD, the sphincter may weaken or relax at inappropriate times, causing stomach acid to flow back into the oesophagus, thereby causing various symptoms.

If left untreated, GERD can lead to significant complications. While occasional acid reflux is common and typically not alarming, GERD is characterised by chronic reflux, which can result in serious issues such as oesophagitis, Barrett’s oesophagus, and a heightened risk of oesophageal cancer. It is essential to seek medical attention if GERD symptoms persist.

Distinction Between GERD and Related Conditions

GERD vs Acid Reflux

While GERD and acid reflux are interconnected, they differ significantly. GERD is a chronic and more severe manifestation of acid reflux, characterised by persistent symptoms.

GERD vs Heartburn

Heartburn refers to a burning sensation felt in the chest, typically behind the breastbone, which may radiate towards the mouth. It is caused by the reflux of stomach acid. GERD encompasses a broader range of symptoms and complications, extending beyond occasional heartburn.

Risk Factors

Certain factors can weaken the lower oesophageal sphincter and increase the likelihood of developing GERD:

Risk Factor	Description
Obesity	Increased abdominal pressure can elevate the risk of stomach acid refluxing into the oesophagus.
Hiatal Hernia	A condition where part of the stomach bulges through the diaphragm, weakening the LES.
Dietary Choices	Certain foods such as spicy dishes, fatty foods, chocolate, caffeine, alcohol, and citrus can trigger symptoms.
Pregnancy	Hormonal changes and abdominal pressure from a growing uterus can exacerbate GERD symptoms.

Symptoms of GERD

Symptoms can vary among individuals, but common ones include heartburn, regurgitation of stomach acid (sour or bitter taste in the throat or mouth, particularly after meals or when lying down), chest pain, difficulty swallowing, chronic cough, hoarseness, sensation of a lump in the throat, and bad breath.

Diagnosing GERD

Diagnosis typically begins with a discussion of symptoms and medical history, followed by a comprehensive physical examination. Diagnostic methods may include:

Upper Gastrointestinal (GI) Endoscopy: A flexible tube with a camera is used to examine the lining of the oesophagus and stomach. Biopsies may be taken for further analysis.
Prolonged Oesophageal pH Study: This involves placing a small tube with a sensor into the oesophagus to measure acid reflux severity over 24 hours.

Treatment Options for GERD

Many individuals wonder if GERD is curable. For some, GERD may be a temporary condition that improves with lifestyle changes, medications, or other treatments, leading to occasional flare-ups. However, for many, ongoing treatment may be necessary, and some may continue to experience symptoms despite medication.

Treatment options include:

Lifestyle modifications

Avoid trigger foods and beverages that worsen reflux, including spicy foods, fatty foods, citrus fruits, tomatoes, chocolate, caffeine, alcohol, and fizzy drinks.
Consume smaller, more frequent meals, refrain from lying down or bending over after eating, and elevate the head of the bed to alleviate nighttime reflux.
Achieving a healthy weight can reduce pressure on the stomach, alleviating symptoms.
Quitting smoking can enhance symptoms and decrease the risk of GERD-related complications.

Medications

For mild symptoms:

Antacids as short-term relief by neutralising stomach acid (e.g., Gaviscon).
Histamine receptor antagonists to reduce acid production and offer longer-lasting relief than antacids (e.g., cimetidine, famotidine).

For moderate to severe symptoms:

Proton Pump Inhibitors (PPIs)to effectively reduce stomach acid. Some PPIs are available over the counter, while others may require a prescription (e.g., omeprazole, pantoprazole).

Surgical intervention

In severe cases of GERD that do not respond to lifestyle changes or medications, or in cases of complications such as hiatal hernia, oesophageal strictures, or Barrett’s oesophagus, surgical procedures like fundoplication may be considered.

Preventing GERD

Preventing acid reflux can be achieved through lifestyle and dietary modifications:

Consider minimising or eliminating spicy foods, citrus fruits and juices, tomato products, chocolate, mint, fried and fatty foods, carbonated beverages, caffeine, and alcohol.
Maintain a healthy weight to alleviate pressure on the abdomen and reduce reflux risk.
Opt for smaller, well-balanced meals to prevent overeating.
Avoid late-night eating, allowing at least three hours between the last meal and bedtime to reduce reflux symptoms.
Sleep on the left side to help direct stomach fluid away from the oesophagus.
Refrain from smoking, as it can weaken the LES, contributing to reflux.
Manage stress through meditation, yoga, or deep breathing exercises, as chronic stress can exacerbate reflux symptoms.

Schedule an Appointment at Gleneagles Hospitals

GERD is a chronic condition that can significantly affect one’s quality of life. If you suspect you may have GERD, please contact us to book an appointment or visit our team of Gastroenterologists at your nearest Gleneagles Hospital.

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