What is Gastroesophageal Reflux Disease (GERD)?
Gastroesophageal Reflux Disease (GERD) is a digestive disorder that is caused by stomach juices or food and fluids frequently flow back up from the stomach into the oesophagus. This phenomenon is also known as acid regurgitation or gastroesophageal reflux.
A patient is diagnosed with gastroesophageal reflux disease (GERD) if they experience acid reflux symptoms more than twice a week.
“This reflux irritates the lining of your oesophagus and is known as GERD. You may feel some discomfort, tightness or a burning sensation in your heart and chest, which is called heartburn. If left untreated, it may lead to serious complications.”
– Dr Ganesh Ramalingam
What Causes GERD?
At the entrance to one’s stomach, there is a valve called the lower oesophageal sphincter (LES). Typically, the LES opens when you swallow and closes as soon as food passes. This prevents acid or stomach contents from travelling from the stomach back into the oesophagus. However, when the LES does not close all the way, stomach acid can move into your oesophagus. This is known as GERD.
What Are the Risk Factors That Cause GERD?
Several factors may increase your risk of developing GERD; they are:
- Being overweight or obese
- Presence of hiatal hernia
- Having a connective tissue disorder
At the same time, a particular lifestyle and dietary habits can also cause your condition to worsen. These habits include:
- Consuming large meals at one time
- Eating close to bedtime (within 1-2 hours before sleep)
- Overconsumption of fatty or fried foods
- Drinking coffee, tea, or alcohol
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin
“I probably had acid reflux the entire time I was training but didn’t know it,” says Spitz, “I had indigestion a lot and figured it was because I used to eat before and after I swam my practice or was from training indoors and breathing in chlorine. I got in the habit of thinking that if I didn’t have that burning pain, then I must not have trained hard enough.”
His condition persisted even after he stopped competitive swimming. Spitz was still experiencing heartburn, and he knew something was wrong.
His doctor prescribed Nexium, a proton pump inhibitor (PPI), which helps prevent the cells in the stomach from producing excess acid and therefore reduce the symptoms of acid reflux.
After which, he reported that his condition improved dramatically. He now aims to raise awareness about acid reflux as he knows that there are effective methods to manage the disease.
What Are the Symptoms or Warning Signs if I Have GERD?
Other symptoms of GERD include:
- Bad breath
- Chest pain
- Difficulty swallowing (dysphagia)
- A dry cough, hoarseness or sore throat
- Regurgitation of food or acid reflux
- The sensation of a lump in your throat
If you experience these symptoms more than twice a week, you may be advised to seek medical advice immediately.
How Can GERD Be Prevented?
Specific lifestyle changes and dietary habits may help you reduce the frequency of acid reflux, thereby minimising the chances of developing GERD. You may consider:
- Adjusting your meals times and bedtime. Lying down on the bed immediately after a meal can lead to acid reflux, as the contents have yet to be digested. Consider waiting at least three hours after a meal before you lie down or go to bed.
- Maintaining a healthy weight. Excess weight can lead to stress on your abdomen. As a result, your stomach may be pushed back up, causing acid to reflux into your oesophagus.
- Stop smoking. Smoking decreases the lower oesophageal sphincter’s ability to function correctly. As a result, the acid may flow back up the oesophagus with the weakening of the muscles.
- Stop drinking alcohol, tea, coffee and carbonated drinks. Alcohol and the other drinks mentioned can cause the stomach to produce additional acid. They can also cause the tissue along the stomach to be more sensitive to acid, which can aggravate your GERD symptoms.
- Raise the head end of your bed if you frequently experience heartburn while you are trying to sleep. You can use blocks of wood placed below the feet of your bed. This will raise the head end of your bed by 6 to 9 inches. Elevating your head and chest above your stomach effectively reduces the chance of acid reflux.
- Consuming food slowly and chewing thoroughly. Slowing down chewing during a meal allows you to produce more saliva, which helps to neutralise the acidity of one’s stomach acid.
- Avoiding food and drinks that trigger acid reflux. Some common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
- Avoiding tight-fitting clothes. Clothes that fit tightly around your waist places pressure on your abdomen and the lower oesophageal sphincter, which may lead to acid reflux.
How Is GERD Diagnosed?
Your doctor may schedule you for a gastroscopy, biopsy and/or diagnostic imaging tests such as an upper GI series test, CT scan, PET scan, or MRI through a physical examination.
Gastroscopy works by letting the doctor see the lining of your oesophagus, stomach, and top part of the small intestine. During this procedure, biopsies, which are tissue samples, are taken and sent to the lab to check if there is cancer.
What Are the Potential Complications of GERD?
For most people, GERD can be treated without severe complications. However, it can lead to serious health problems that affect the quality of life and potentially life-threatening conditions if left untreated.
These possible complications include:
- Oesophagitis, which refers to an inflammation of your oesophagus.
- Oesophageal stricture, this condition leads to the narrowing or tightening of the oesophagus.
- Barrett’s oesophagus, this condition causes the permanent changes to the mucosal lining of your oesophagus.
- Oesophageal cancer, the cancer which develops from Barrett’s oesophagus.
- Asthma, chronic coughing, or other breathing problems, which may develop from breathing stomach acid into your lungs
- Erosion of tooth enamel, gum disease, or other dental problems
To reduce the chances of complications, it is essential to prevent and treat the symptoms before they worsen.
As with the case of actress and TV presenter Lizzie Cundy, she shared her experience with the Mirror about her struggles with GERD and its complications.
“After going for a curry with friends on a rare night off in October last year, I woke up in the early hours with pains like you wouldn’t believe – terrible heartburn but more intense.”
Her doctors were able to determine through a gastroscopy examination, that Lizzie had massive stomach ulcers that had been there for almost three years. Additionally, she was diagnosed with another condition, Barrett’s Oesophagus.
“…but the doctor told me that stomach acid had made its way to my throat and basically burnt my oesophagus. It had also caused the cells in the lining of my oesophagus to change and develop into pre-cancerous cells, which was shocking news,” when Lizzie recounted the breaking of the news of her condition.
To treat her condition, Lizzie was prescribed a strict diet and long-term medication to reduce excess stomach acid. Lizzie also focused on changing her lifestyle, such as reducing her alcohol intake.
How Is GERD Treated?
Besides making changes to your lifestyle and eating habits, GERD can be treated through medications and surgeries.
Based on the severity of one’s condition, your doctor may recommend taking over-the-counter medications, like:
- H2 receptor blockers
- Proton pump inhibitors (PPIs)
If medications fail to effectively treat the condition, surgery may be recommended by your doctor.
“Following my 20-year career with the Baltimore Orioles, I became a colour commentator for the ABC and ESPN television networks. I normally ate late at night after broadcasting a game and invariably ended up with heartburn. I tried taking over-the-counter products to no avail. I also tried elevating my bed, avoiding the common heartburn food triggers like chocolate, caffeine, and tomatoes, and changing my eating habits to allow three hours between eating and going to bed. None of these efforts solved the problem.”
While he struggled with the condition, his condition was helped when he was given a prescribed medication – a proton pump inhibitor (PPI). As Jim recounts, “I certainly can’t speak for everyone, but I can tell you what my own experience has been with a PPI. My heartburn and other GERD symptoms have been under control since taking one PPI capsule a day – except in those few cases where I forgot to take my medication, and the heartburn returned. I now recognise that I suffered needlessly before getting the appropriate treatment.”
What Is the Recommended Surgery for Treating GERD?
Laparoscopic Nissen Fundoplication is the most common surgical procedure used to treat some gastroesophageal conditions such as GERD. When performing a Laparoscopic Nissen Fundoplication, a surgeon will attach a part of the stomach to the lower oesophageal sphincter to reduce acid reflux.
Laparoscopic Nissen Fundoplication is the most recommended surgical treatment of severe GERD as it involves several smaller incisions. Miniaturised instruments are also used to make the process less invasive.
Research has also shown that this type of surgery has a high long-term success rate to prevent a recurrence.
Why Anti-Reflux Surgery for GERD?
For patients suffering from severe GERD complications with minimal success from medication, you may be advised by your doctor to consider surgery.
Persistent and severe heartburn can affect one’s health and quality of life. If left untreated, GERD reduces personal and work-related productivity. Seventy-five per cent of nighttime heartburn patients report being unable to sleep well at night, and forty per cent of nighttime heartburn patients say it affects their jobs the next day.
Over time, acid reflux may lead to a change in the oesophagus lining, resulting in conditions such as Barrett’s oesophagus. Barrett’s oesophagus is a precancerous condition which increases the risk of oesophageal cancer.
GERD can effectively be treated with surgical anti-reflux therapy. By correcting underlying problems, surgery helps patients avoid the need for life-long medications. Within a few weeks, patients will likely be symptom-free. This ensures that GERD does not cause pain or discomfort or progress to more severe conditions like ulcers or cancer.
What Is the Outlook for Someone With GERD?
While GERD can impact your quality of life, early intervention can prevent it from becoming a life-threatening condition. Effectively managing the condition and its symptoms can also help the patient lead a healthier and improved quality of life.
Should you suspect that you have GERD, you may want to seek medical advice on the most effective way to treat your GERD and lower the risk for associated complications.
Schedule a consult with our doctor Dr Ganesh Ramalingam
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