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Gastroesophageal Reflux Disease (GERD)

GERD or Gastroesophageal Reflux Disease

When gastric juice refluxed into the oesophagus exceeds its normal limits, it is termed as gastro-oesophageal reflux disease or GERD, in short. GERD is normally experienced after a meal. Endogenous defense mechanisms such as the LES (lower oesophageal sphincter), which is the muscle located between the oesophagus and the stomach, becomes defective. It is overwhelmed when there is a large amount of bile or acid-containing fluids for a prolonged period in the oesophagus. Acidic gastric secretions show retrograde movement into the oesophagus from the stomach and duodenum, which is an etiologic factor.

A hiatal hernia is a major contributor to reflux leading to weakening of the LES. The LES migrates into the chest proximally and loses its HPZ or abdominal high-pressure zone. The length of the HPZ may also decrease. As a result, diaphragmatic widening is experienced due to a hernia. Some of the stomach moves into the chest through this opening in the diaphragm. Morbidly obese patients show a high prevalence of GERD.

Causes or factors contributing to GERD

  • Dysfunctional LES is the main cause of GERD
  • Lifestyle choices
  • Consuming foods and beverages such as alcohol, chocolate, coffee and fatty meals
  • Medications such as calcium channel blockers, nitrates and anticholinergics
  • Hormones like progesterone
  • Nicotine usage

Signs and Symptoms

Atypical oesophageal symptoms:

  • Hoarseness
  • Wheezing or dry cough
  • Chest pain (non-cardiac)
  • Otitis media
  • Erosion of enamel
  • Any other dental manifestation

Typical oesophageal symptoms:

  • Dysphagia
  • Heartburn
  • Regurgitation
  • Nausea
  • Vomiting

Diagnosis

  • EGD or upper gastrointestinal endoscopy to identify the severity of the disease; it also reveals complications such as strictures, Barret oesophagus and oesophagitis)

  • pH monitoring – an ambulatory 24 hour pH monitoring to establish the sensitivity and specificity of GERD; the correlation between reflux and episodes of reflux is analyzed

  • Oesophageal manometry defines the LES location and correctly positions the probe for the pH monitoring

  • Double contrast radiographs will show the presence of neoplastic diseases

  • Intra-luminal oesophageal electrical impedance will provide impedance measurements to detect acid and non-acid refluxes; usually conducted in conjunction with the 24-hr pH testing

Treatment and medication

Treatment usually involves lifestyle modifications such as weight loss, avoiding foods and beverages like alcohol, chocolate, and citrus juice. The patient is told to avoid large meals and wait for 3 hours before lying down with an elevated head of about 8 inches. Pharmacological therapy may include antacids, H2 blocker therapy and H2 receptor antagonists, prokinetic medications, reflux inhibitors, and proton pump inhibitors.

Dr. Deepak provides the right treatment for GERD to avoid long-term complications of the disease.

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