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Gastro-esophageal reflux disease or acid-reflux disease is a condition in which the contents of the stomach reflux backwards into the esophagus (food pipe). Since the stomach contents are acidic in nature, this damages the inner lining of the food pipe and causes symptoms of heartburn, pain, etc
There are multiple causes responsible for initiating GERD, and different causes may be functioning in different individuals or even in the same individual at different times. The commonest causes responsible for GERD have been listed below:
• Functional abnormalities of the lower esophageal sphincter
• Hiatus Hernia:- A condition in which there is protrusion of the stomach up into the opening normally occupied by the esophagus in the diaphragm [the muscle that separates the chest (thoracic) cavity from the abdomen.
• Abnormal esophageal contractions:- Co-ordinated esophageal contractions cause the forward movement of food from the esophagus into the stomach. When the wave of contraction is defective, the refluxed acid is not pushed back into the stomach and it can cause damage to the lining of the esophagus.
• Delayed emptying of the stomach:- When food remains in the stomach for a longer duration, the stomach is distended for longer time and this increases the chances of reflux of the stomach contents.
• Dietary habits: Fatty and fried foods, chocolates, garlic and onions, drinks with caffeine, acid foods such as citrus fruits and tomatoes, spicy foods, mint flavorings, pungent foods, etc
• Habits: Use of alcohol, cigarettes; poor posture (slouching) especially after meals
• Drugs: Calcium channel blockers, antihistamines, theophylline, nitrates,
• Eating habits: Large meals, eating soon before sleeping
• Other contributory conditions: Obesity, pregnancy, diabetes, rapid weight gain, etc.
• Stress: Though this has not been directly linked to GERD, most patients report an increase in their symptoms during stressful times.
• Other medical conditions: Diabetes, pregnancy, Obesity
Uncomplicated GERD presents with the following symptoms commonly:
• Heartburn: This is the commonest presentation of GERD. Patients often complain of burning pain in the middle of chest region (retrosternal). The pain may also be present in the upper part of the abdomen and sometimes travels up to the throat. Occasionally the pain may be sharp or pressing instead of burning. The pain is worse after meals and can last upto a couple of hours. Symptoms may be worse on lying down.
• Regurgitation: The refluxed stomach contents may come into the throat or mouth and this may occur especially on bending or sleeping. There may be a feeling of ‘something stuck in the throat’.
• Dry cough, hoarseness of voice, bad taste in the mouth are other symptoms caused due to the regurgitation of the food.
• Occasionally patients may develop nausea (though this is not very frequent) and GERD should always be considered in patients who have unexplained nausea.
• In children, the common symptoms are vomiting, coughing and other respiratory problems.
Diagnosis of GERD is frequently done based on the symptoms and often physicians put the patients on a therapeutic trial of antacids. But it must be remembered that patients responding positively to therapeutic trial of antacids do not always have GERD; they may well be suffering from some other condition (Gastric ulcer, duodenal ulcer, etc).
Following are the commonest investigations done to diagnose GERD:
• Upper Gastrointestinal Endoscopy: Also commonly known as OGD scopy or Oesophago-gastro-duodenoscopy (endoscopy of the upper digestive tract). This involves viewing the inside of the food pipe, stomach and upper part of intestine using a fibre-optic tube to look out for any inflammation, erosions, ulcers and to rule out any complications of GERD.
• Biopsy of the esophagus is more important for ruling out cancer of the esophagus or other cellular changes as a cause of heartburn. A biopsy can also pick up other cellular changes that may be complications of GERD.
• Specialised x-ray of the esophagus (called esophagram) using barium as contrast: This is done to rule out complications of GERD such as ulcers, strictures, etc. This test is not used frequently nowadays and Endoscopy remains the primary diagnostic test.
• Esophageal motility testing: To evaluate the function of the muscles of the esophagus.
• Gastric emptying studies: To detect if the patient has slow emptying of the stomach.
• Esophageal acid testing: To determine the amount of time during 24 hours that the esophagus contains acid.
Surgery and other procedures used if medications don’t help
Most GERD can be controlled through medications. In situations where medications aren’t helpful or you wish to avoid long-term medication use, your doctor may recommend more-invasive procedures, such as:
• Surgery to reinforce the lower esophageal sphincter (Nissen fundoplication). This surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus. Surgeons usually perform this surgery laparoscopically. In laparoscopic surgery, the surgeon makes three or four small incisions in the abdomen and inserts instruments, including a flexible tube with a tiny camera, through the incisions.
• Surgery to strengthen the lower esophageal sphincter (Linx). The Linx device is a ring of tiny magnetic titanium beads that is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the opening between the two closed to refluxing acid, but weak enough so that food can pass through it. It can be implanted using minimally invasive surgery methods. This newer device has been approved by the Food and Drug Administration and early studies with it appear promising.
Note:- Cost of Gastroesophageal Reflux (GERD) Treatment in India at Best Gastroenterology Hospitals in India , above include stay in a Private Room for specific number of days where a companion can stay with the patient, surgeon fee, medicines and consumables, nursing care and food for the patient. More accurate treatment cost estimates can be provided if medical reports are emailed to us or after the patient is examined by doctors after arrival in India and medical tests are done.
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