Gastroesophageal reflux disease (GERD)

Nature has provided a one-way valve mechanism between the food pipe and stomach (lower esophageal sphincter) that allows flow of contents from food pipe to stomach only. If this sphincter muscle becomes weak / inefficient then contents of the stomach can reflux back into the food pipe that causes irritation to the lining of the food pipe leading to symptoms such as heart burn. Repeated reflux of acid into the food pipe can cause GERD.  Majority of such patients can be managed with life style modifications or medications but some patients may need surgery for symptom control.

  1. Heartburn i.e. burning sensation in the chest usually after meals that may worsen at night or on lying down
  2. Regurgitation of sour liquid or food into the mouth
  3. Difficulty while swallowing
  4. Chest pain or upper abdominal discomfort
  5. Feeling of lump in throat
  6. Longstanding dry cough
  7. New onset or worsening of asthma

Some of the factors / conditions that may increase the risk of GERD include:

  1. Obesity
  2. Hiatus hernia
  3. Pregnancy

While smoking, drinking alcohol or coffee or eating late at night or large meals may aggravate the reflux of acid.

After thorough evaluation including history of your symptoms and physical examination your doctor will prescribe following investigations:

  1. Upper GI endoscopy – the lining of the esophagus, stomach and first part of the duodenum is examined with the help of endoscope
  2. 24 hour pH monitoring – this test checks the acid levels in the esophagus over a period of 24 hours
  3. Esophageal manometry – this test checks the muscle of the esophagus

Treatment will depend on the severity of symptoms, age and general condition of the patient.

Management options include

  • Lifestyle and dietary modifications: such as avoiding alcohol, smoking, aerated beverages, citrus foods and oily / fried foods. Also eating small meals, a gap of few hours between dinner and sleeping may help.
  • Medical treatment: includes medications to suppress acid secretion in stomach and promotility medications that promote motility of stomach.
  • Surgery: only few patients need surgery for GERD. Surgery for GERD is called as Laparoscopic Fundoplication wherein part of the stomach is wrapped over lower esophagus.

Surgery for GERD is a safe procedure and is usually performed by laparoscopic technique. Following surgery, you are likely to be discharged from the hospital in couple of days. Few patients may complaint of mild, transient difficulty in swallowing or belching in the immediate period after surgery that usually settles with time.