GERD
What is GERD?
GERD or gastro esophageal reflux disease is a condition characterized by chronic heartburn and irritation in the esophagus. The burning sensation or irritation is caused by the occasional reflux of the stomach acid or bile back into the esophagus (the food pipe). The regular backwash of the stomach acid or bile may cause irritation and inflammation in the food pipe. As a result, the pipe may narrow down or have ulcers. It also contributes to a slightly increased risk of esophageal cancer.
Many people suffering from GERD seek relief from heartburn through lifestyle modifications and using OTC medications. However, eliminating the condition may require more powerful medicines and, sometimes, even surgery.
Symptoms of GERD
The most common symptom of GERD is Heartburn. It is a burning sensation in your chest. Sometimes the sensation may spread to the throat, and may leave a sour taste in your mouth. The heartburn may be mild to severe, depending upon the severity of the condition.
Chest pain is also a common symptom of GERD. The pain may be especially acute during sleeping time at night. Chest pain and heartburn may also coincide or may take place simultaneously.
GERD can also result in difficulty in swallowing. This situation where a person finds it difficult to swallow is known as dysphagia.
The symptoms may also include Coughing and wheezing. Occasionally, the patient may also suffer from asthma, hoarseness or sore throat.
Regurgitation is also a common symptom with GERD. The patient may regurgitate food or sour liquid.
Diagnosis of GERD
There are various tests available for diagnosing GERD. Among these, barium X ray test, endoscopy and acid probe (pH) tests are the most common.
Barium X ray Test: This test requires the patient to drink a barium solution which coats the hollows inside the digestive tract. This helps the doctor to discern the x rays for the shape and condition of the esophagus. It also helps in determining any abnormality in the stomach, intestines or duodenum. If a hiatal hernia is contributing to the inflammation, the x ray also reveals that. Other esophageal problems, such as narrowing, stricture and growths contributing to difficulty in swallowing can also be tested through this test.
Endoscopy: The test with the help of an endoscope may also reveal valuable information about any abnormality in the digestive tract. The endoscopy related to GERD is known as esophagogastroduodenoscopy (EGD). The insertion of an endoscope (a thin tube with a camera and light) reveals if there is any ulcer or inflammation in the esophagus or the stomach. Moreover, through endoscopy Barrett’s esophagus, a condition where precancerous growth may be seen in the cells of esophagus, or cancerous growth may also be checked. A biopsy to detect the presence of bacterium may also be performed by the doctor.
Ambulatory acid (pH) probe test: This test uses measurement of acid to identify when and for how long the acid regurgitates into your esophagus. In this test, a catheter with acid probes is inserted into the esophagus. The catheter is inserted into the esophagus for measuring the acidity of the stomach acid that regurgitates back into the esophagus. The catheter is other end is attached to a computer which records the acid measurements. The most result-oriented of these test, a Bravo pH test is considered to be more effective and comfortable.
Causes of GERD
GERD is caused by an abnormal function of the lower esophageal sphincter (LES). Usually, the sphincter, a group of muscles at the end of the esophagus, is responsible for allowing the swallowed foods pass through it. This happens because of the opening of the sphincter while swallowing. However, due to abnormality, the sphincter may open, sometimes, to allow the backwards flow of the stomach acid which is rich in acid content and harmful for the esophagus. The backwash is harmful for the esophagus and is responsible for the various symptoms such as heartburn and inflammation of the esophageal lining.
A hiatal hernia may also be responsible for the backwash of the acid into the esophagus. In this condition, a part of the stomach is projected into the lower chest. This may lead to weakening of the sphincter muscles, which in turn can make the GERD symptoms worse.
Alcohol use, pregnancy, smoking or excess weight may also contribute to GERD. Also, it is found that some foods may aggravate the condition, including citrus fruits, chocolate, garlic and onions, mint flavorings, drinks with caffeine, fatty and fried foods, spicy foods, tomato-based foods, like spaghetti sauce, chili, and pizza etc.
Treatment of GERD
There are various treatment options available for GERD. Over the counter and prescription strength medications and surgical procedures are the most common types of treatment for GERD.
Over the counter medications
Antacids: Antacids are especially useful to calm down the influence of the stomach acids on the esophagus. The most common antacids include Maalox, Mylanta, Gelusil, Rolaids and Tums. However, antacids alone cannot provide full relief from the ill effects of reflux. Moreover, some antacids are also known to exert side effects, such as diarrhea or constipation.
H-2-receptor blockers: The H-2-receptor blockers decrease the production of acids and may be useful as they provide relief for longer period of time. Some of the most effective H-2-receptor blockers include famotidine (Pepcid AC), nizatidine (Axid AR), cimetidine (Tagamet HB) and ranitidine (Zantac 75). These medications start working after about 30 minutes. Hence these should be taken before meal that may potentially increase the symptoms. These medications also provide relief during bed time if taken early.
Proton pump inhibitors: Proton pump inhibitors are useful for their function of blocking the production of acids. They also provide enough time to the esophagus to heal. Omeprazole (Prilosec) is the most famous among the proton pump inhibitors. However, the use of these inhibitors should be limited as long term use may result in considerably effective side effects.
Prescription strength medications
Prescription strength medications are useful for the severe types of GERD. These may be useful in the cases where heartburn leads to an inflammation of the esophagus. These medications work the best when taken about 30 minutes before meal.
Prescription-strength H-2-receptor blockers, prescription-strength proton pump inhibitors and prokinetic agents fall under this category. The H-2-receptor blockers include Axid, Pepcid, Tagamet and Zantac. The most common proton pump inhibitors include iansoprazole (Prevacid), esomeprazole (Nexium), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex). The prokinetic agents help the stomach empty more rapidly and also to tighten the valve between the stomach and the esophagus.
Surgery
Surgical procedures are less common in cases of GERD. However, if medications fail to provide relief or the patient can’t tolerate the medicines, surgery may be advised. Surgery may also be an option if a large hiatal hernia is behind GERD or there are severe esophagitis, especially with bleeding. Recurrent narrowing (stricture) of the esophagus and pulmonary problems, including severe bronchitis or pneumonia, due to acid reflux may also need surgical methods of treatment.
Living with GERD
Living with GERD, without precautions, may be a stringent task. However, taking simple steps, one can reduce the severity of the symptoms. The most important step in this direction is to take smaller meals that reduce the pressure on the esophageal sphincter. Wearing loose belts that provide relief from the excess pressure is also important. Avoiding sleeping right after taking a meal is also effective in reducing the severity of the symptoms. Raising the head end of your bed may also be useful.
Prevention of GERD
Prevention of GERD is not always possible. However, taking some steps to reduce the severity of the symptoms may be helpful. Controlling the weight is one of the best steps. Avoiding the triggers, such as fatty or fried foods, alcohol, chocolates etc. may also be helpful in preventing GERD. Another important way to prevent GERD is to stop smoking which effects adversely on the stomach’s functioning.
