Overview of GERD
Gastroesophageal reflux is a normal physiological phenomenon experienced intermittently by most people, particularly after a sumptuous meal. Gastroesophageal reflux disease (GERD) occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit.
Although highly prevalent in Western countries, where the prevalence of monthly heartburn is about 29–44%,studies had revealed an increase in its frequency in Asian regions caused by the recent globalization, westernization and the associated lifestyle changes.1
Nonerosive reflux disease (NERD) appears to be the most common type of GERD among Asian patients accounting for 50– 70% of cases.2
Gastroesophageal reflux disease has two distinct entities
1. The classic severe acid reflux with erosive esophagitis and its complications. Barrett’s esophagus, a subset of this group has an increased risk of adenocarcinoma.
2. NERD with minimal or no esophagitis.3
Diagnosis of GERD is usually made on clinical grounds. Endoscopy is reserved for patients with distressing symptoms or in order to detect Barrett’s esophagus.
The therapy is aimed at eliminating or reducing the symptoms and improving the quality of life.
Symptom of GERD
Gastroesophageal reflux disease patients present a variety of symptoms, most commonly heartburn and regurgitation.
Heartburn or Chest Pain Which Leads to Heart Attack
Many people misunderstand the pain for being a heart attack, when they are only experiencing the common heartburn.
How GERD develops
Gastroesophageal reflux disease is usually caused by a defect in the relaxation of the lower esophageal sphincter (LES), which consequently allows the stomach contents to reflux into the unprotected lining of the esophagus.
Complications of GERD
Only a minority of patients develops complications of GERD. One complication is the inflammation of the esophagus from stomach acid, which further leads to bleeding and ulcers, a condition called esophageal erosions or esophagitis.
When to Seek Medical Care for GERD
Most problems with heartburn are short-term and mild. However, prescription medications and more intensive intervention are needed in the presence of the following:
- Heartburn several times a week
- Heartburn that causes night awakenings
- Difficulty swallowing
- Persistence of symptoms even after taking medications
- Regurgitation of blood
- Weight loss
Diagnosis of GERD
Generally, GERD diagnosis is done symptomatically. Barium x ray, Endoscopy, Esophageal acid probe test diagnostics tests are carried out to confirm GERD
Treatment of Heart burn / gerd
Treatment of GERD
Over the recent past years, large numbers of GERD sufferers use OTC antacids and other agents that are available without a prescription to treat the discomforts and infrequent heartburn.
Living with GERD
Many people manage the discomfort of heartburn with simple lifestyle modifications and over-the-counter (OTC) medications.
Nevertheless, a 2006 review suggested that evidence for most dietary interventions is only subjective; however, weight loss and elevating the head of the bed were supported by evidence.9
A subsequent randomized crossover study showed the benefit of avoiding eating two hours before bedtime.10
Sleeping on one’s left-side has been shown to significantly reduce episodes of night-time reflux in GERD patients.3 Other positional therapy includes elevation of the head of the bed.The height of the elevation must be at least 6–8 inches (15–20 cm) in order to be minimally effective to prevent the backflow of gastric fluids. As some innerspring mattresses tend to cause back pain when inclined, foam-based mattresses are preferred.
Another effective approach is to apply all the conservative measures for maximum response.
GERD in Elderly
Although GERD is less symptomatic in older patients, the presentation is much more severe as this group tends to have impaired motility of the esophageal muscles, larger hiatus hernias and is more recumbent.
Older patients often have complications including
- Peptic stricture
- ENT and pulmonary complications
Endoscopy is indicated in all elderly patients with GERD regardless of symptom severity. Treatment of GERD in elderly patients is the same as in younger groups.
GERD during Pregnancy
Heartburn is a frequent complaint during pregnancy. The cause is possibly owing to hormonal changes.
Lifestyle modifications and OTC antacids are generally safe. H2 receptor blockers are considered safe but should only be used under the advice of a clinician. Proton pump inhibitors should be used during pregnancy only if clearly needed.
GERD in Infants and Children
Vomiting is the most common symptom of gastroesophageal reflux in infants. Other coexisting symptoms such as irritability, poor feeding or failure to thrive differentiates GERD from physiologic reflux.
Symptoms of GERD in pre-school children include intermittent vomiting, upper abdominal pain, night-time awakening and respiratory symptoms. Older children and adolescents with GERD exhibit symptoms similar to those seen in adults.
As in adults, treatment options for pediatric GERD include lifestyle changes, pharmacological therapy and surgery.
Lifestyle changes in infants include alterations in formula composition and infant feeding techniques. In infants and children who remain symptomatic despite dietary and lifestyle modifications, medications specially H2RBs are recommended.
How can one prevent heartburn?
Many cases of heartburn can be prevented by simple lifestyle modifications in the diet and daily activities similar to those recommended after the problem occur. Such as:
- Keep ideal body weight.
- Avoid foods and drinks such as tomatoes, citrus fruits, garlic, spicy and oily foods, alcohol, tea and coffee that trigger the problem (a study by Stanford University researchers disputes the effect of coffee, acidic and spicy foods in causing heartburn).9
- Eat frequent small meals instead of three large meals.
- Avoid eating just before exercise.
- Stop smoking.
- Avoid analgesics such as aspirin, ibuprofen and other nonsteroidal antiinflammatory drugs.
- Avoid lying down for 2–3 hours after eating.
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Written by: Healthplus24 team
Date last updated: May 08, 2012