GERD (Chronic Acid Reflux) – Symptoms, Causes, Diagnosis, Treatment & Prevention

Gastroesophageal Reflux Disease or GERD is a common condition in which the acid from the stomach moves up to your oesophagus frequently. This condition can damage the cells of the oesophagus, pharynx and the respiratory tract. The condition can occur in any person but it is generally observed in individuals who are pregnant or who have a gastrointestinal problem.

The condition can lead to heartburn, regurgitation, chest pain and other symptoms. This condition can be diagnosed through various tests and then your doctor will form a treatment plan according to the cause of your GERD. The treatment plan usually consists of medications to manage your symptoms.

However if there is no improvement in the symptoms then your doctor may even recommend surgery to control the acid reflux. GERD is not a life threatening condition however it can affect the lifestyle of the patient and thus disrupt their work and relationships. This condition can easily be managed by medications and lifestyle modifications.

GERD- Gastroesophageal Reflux Disease

GERD is a condition in which the sphincter between the stomach and the oesophagus does not work properly. This allows some of the food and acid to pass into the oesophagus. This can lead to damage of the tissues of the oesophagus, pharynx and the respiratory tract. This can occur in anyone at any point of their life however if the symptoms occur more frequently then it can be diagnosed as GERD.

This condition can be recognised by the symptoms experienced by the patients such as heartburn, chest pain, nausea, chronic cough and a hoarse voice. The condition is diagnosed by various diagnostic tests in order to look for the cause of the condition. The condition can be managed through medications and lifestyle modifications but some patients may require surgical interventions in order to treat their symptoms.

If GERD is left untreated for a long time then it can lead to the onset of various complications such as Esophagitis, Esophageal stricture, Barrett’s oesophagus and Esophageal cancer. The article given below will cover all the details regarding GERD such as its symptoms, causes, diagnostic methods, treatment protocols and preventive measures.

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Symptoms of GERD

There are many symptoms of GERD which can make it easy to identify. The most common and characteristic symptom of GERD is heartburn. Some of the common symptoms of the disease are given below.

1. Nausea
2. Chest pain
3. Difficulty in swallowing
4. Chronic cough
5. Pain in your upper abdomen
6. Inflammation in your vocal cords
7. Onset of asthma in adults or worsening of it
8. Feeling of a lump in your throat

These symptoms can occur at any time of the day after a meal but they are generally more common at night time or when your body is in a lying position.

Causes and Risk Factors of GERD

The main cause of GERD is a dysfunction in the sphincter which prevents backflow of food in the oesophagus. This sphincter can open up when it is not required to do so and allow the flow of acid and food in the oesophagus thus damaging the tissues. There are many other causes and risk factors which have been identified in association with GERD. These can lead to an onset of symptoms of GERD. These factors are listed below.

1. Hiatal hernia- This is a condition in which the stomach moves towards the chest. If the diaphragm is affected then it is possible that the sphincter of your oesophagus is affected and cannot do its work properly.
2. Overeating- Frequently overeating any kind of food can lead to a dysfunction in your esophageal sphincter and this allows food and acid to get in your oesophagus.
3. Lying down right after a meal- If you lie down right after you have eaten your meal then it is possible that it can re-enter your oesophagus.
4. Obesity- Obese people tend to have weakened muscles meaning that the sphincter in their oesophagus can also become weak and will not be able to perform its function properly.
5. Pregnancy- GERD is a common occurrence in pregnancy as the growing foetus can put a pressure on the stomach which can force the sphincter to open up and allow the contents of the stomach to move up.
6. Smoking and drinking alcohol- Chronic smoking and drinking alcohol can also lead to the weakening of the muscles of your oesophagus which can cause the sphincter to become weak and unable to close properly. This can cause a reflux of acid and food in your oesophagus.
7. Drug abuse- Chronic usage of many drugs like NSAIDs such as Ibuprofen can also lead to the occurrence of GERD. Use of illegal drugs such as Cocaine can also lead to incoordination in the movements of the oesophagus.
8. Anxiety- GERD has been linked with various mental health conditions but Anxiety can lead to more recurrent episodes of GERD. Severe anxiety attacks can lead to an increase in the frequency of the episodes of GERD.

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Diagnosis of GERD

There are many methods available which can help in the diagnosis of GERD. The most commonly used methods are given below.

1. Ambulatory acid probe test- In this test, a small monitor is inserted into your oesophagus in order to monitor the amount of acid that enters your oesophagus and for how long it enters there. This test is monitored for 24 hours and it is considered a gold standard for diagnosing GERD.
2. Upper Endoscopy- This test is conducted by inserting an endoscope in your oesophagus and to look for any signs of inflammation and other complications. A sample of tissue collected via this procedure can be studied to look for any complications.
3. X-ray- X-rays are conducted when a person is having difficulty in swallowing. The X-ray is conducted after you drink a chalky liquid of barium in order to make out the silhouette of the lining of your oesophagus and your stomach.
4. Esophageal manometry- This procedure measures the rhythmic contractions of your oesophagus after you swallow. This can measure the coordination and force of the muscles of your oesophagus and to detect 
5. Transnasal esophagoscopy- In this procedure, the endoscope is inserted through your nose and moved into your oesophagus to take a look at your oesophagus.

Treatment of GERD

The symptoms of GERD can be managed through various medications and surgical interventions. The commonly used medications and surgeries are given below.

• Medications- Most of the medications which are used for the treatment of GERD are available over-the-counter but the higher doses of the medications are only available on prescription.
  • Antacids- These medications can be bought over the counter and on prescription. These medications work by neutralising the excess acid which is present in the stomach and thus preventing the symptoms of heartburn.
  • H2 receptor blockers- These medications work by lowering the production of acid in your stomach. They can include Famotidine and Nizatidine which are available on prescription and some medications in lower doses can be bought over-the-counter.
  • Proton pump inhibitors (PPIs)- These medications also work to lower the amount of acid production but they are more effective than H2 blockers and they also promote the healing of the esophageal lining. These medications can be bought over-the-counter and on prescription. These medications usually include Esomeprazole, Omeprazole, Rabeprazole and Pantoprazole.
• Surgical interventions- If the symptoms of GERD cannot be managed with medications then your doctor may recommend you to undergo the following surgical procedures in order to manage your condition.
  • Fundoplication- In this procedure, the surgeon wraps the lower part of your stomach around the lower portion of your oesophagus in order to tighten the sphincter and prevent the reflux of acid. This is a minimally invasive procedure and can be completed without any complications.
  • LINX device- In this procedure, a tiny ring of magnetic beads is used to wrap the lower portion of your oesophagus. The magnetic attraction of the beads tightens the sphincter and prevents the reflux of acid. This procedure is also a minimally invasive surgery and the beads do not have any side effects on the person.
  • Transoral incisionless fundoplication (TIF)- This procedure is a new technique in which the lower portion of oesophagus is wrapped with the help of polypropylene fasteners. This procedure does not require any incision and it is performed with an endoscope through the mouth.

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Prevention of GERD

There are many ways by which you can prevent the occurrence of GERD. The following methods have been found effective in the prevention of GERD.

1. Maintain a healthy body weight- Exercise regularly and maintain a healthy body weight in order to avoid any weakening of the muscles of your oesophagus.
2. Eat small quantities- Always ensure that you do not overeat and eat your food in small portions. This can prevent the symptoms of GERD.
3. Reduce fats in your diet- Fats can increase your existing symptoms of GERD and can also lead to the occurrence of these symptoms. You should cut down butter, salad dressings, fatty meats and full-fat dairy products.
4. Maintain a good posture while eating- You should always sit upright when you eat in order to avoid any kind of pressure on your stomach which can cause your food to go back in your oesophagus.
5. Avoid eating before bedtime- GERD symptoms tend to aggravate at night when the patient is lying down. You should avoid eating any meals at least 3 hours before you go to sleep. Also make sure that you always take a pillow so that your head is elevated and there is no chance of reflux.
6. Avoid smoking- Smoking can irritate your oesophagus and can also weaken the sphincters of your oesophagus. Quitting smoking can prevent the onset of the symptoms of your GERD.
7. Avoid foods which trigger your GERD- If you notice that your GERD occurs after you eat certain kinds of food items then you should avoid these food items in order to prevent your symptoms.

Complications of GERD

GERD does not lead to any life-threatening symptoms but if it is left untreated for long then it can lead to severe complications in the patients. Some of the complications of GERD are listed below.

1. Esophagitis- This is a condition which is characterised by inflammation in your oesophagus due to long term damage by GERD.
2. Esophageal stricture- This condition occurs when the oesophagus narrows due to recurring damage and healing of the tissues in your oesophagus.
3. Barrett’s oesophagus- This is a serious complication which arises in cases of long term recurring GERD. In this condition, there is permanent and irreversible damage to the lining of your oesophagus.
4. Esophageal Cancer- This is a rare complication and occurs in only a small portion of people who have Barrett’s oesophagus.

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