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Overview
“Gastro-” refers to the stomach. “Oesophageal” refers to the oesophagus, or feeding tube, that connects the mouth to the stomach. “Reflux” refers to backflow. Gastroesophageal Reflux hence refers to backflow of stomach contents into the oesophagus.
GERD is a disorder where patients suffer from sensations of heartburn and acid indigestion and sometimes is confused with chest pain due to cardiac causes. GERD occurs when the lower oesophageal sphincter does not close properly after food has entered the stomach, resulting in a backflow of stomach contents up the oesophagus.
Physiology
Food normally swallowed passes into the stomach via the oesophagus. Upon entering the stomach, the lower oesophageal sphincter (ring of muscle) closes, thereby preventing stomach contents from backflowing back into the oesophagus while the stomach digests and churns the food.
GERD happens when the lower oesophageal sphincter fails to close properly and reflux of stomach contents occurs. This results in a sensation of burning in the chest as stomach contents are normally acidic in nature.
The degree of severity of GERD hence depends on the magnitude of dysfunction of the lower oesophageal sphincter, stomach contents, and back pressure exerted by the stomach.
Causes
From first principles, anything that increases the back pressure exerted by the stomach can potentially cause GERD. These include:
- Diet and Lifestyle: Binge eating, excessive consumption of alcohol, smoking, obesity and certain foods and beverages like coffee have all been implicated with GERD
- Pregnancy.
- Structural abnormalities like a hiatus hernias (outpouching of stomach above the diaphragm).
Symptoms
Patients often complain of “indigestion” or “heartburn”, described as a burning sensation behind the breast bone ascending up towards the throat and neck. Often associated with an acidic or bitter taste, the sensation of heartburn can last for as long as 2 hours and is made worse by lying flat.
Heartburn is often confused with chest pain due to cardiac causes. It is important to differentiate the two because heartburn is treatable while cardiac causes for chest pain carries a significant risk of morbidity.
If in doubt, always consult your physician.
Treatment
Lifestyle and Dietary changes are the mainstay of treatment for GERD.
It is recommended to reduce consumption of acidic foods like citrus fruits and juices, tomatoes, foods that compromise the lower oesophageal sphincter like chocolate, fatty foods, alcohol, and any foods known to cause irritation in specific patients.
Control of serving portions and reduction thereof will also help control symptoms of GERD. Eating meals at least 2 hours prior to sleep will reduce incidence of reflux. Reduction of weight and overcoming obesity will relieve GERD.
Cessation of smoking and reduction of alcohol consumption will both help GERD.
Simple changes of posture during sleep like sleeping on an incline can help GERD.
Beyond lifestyle and dietary changes, medications like antacids help combat symptoms caused by stomach acids and can provide partial relief. Use of antacids for the long term, however, risk aberrations in blood calcium and magnesium levels, which in turn can cause serious problems for patients with kidney disease.
Other medications available include prescription medications like histamine antagonists (eg commonly sold Famotidine in Singapore) and proton pump inhibitors (eg. Omeprazole).
Patients with persistent GERD despite the above treatments might require more invasive investigations like having endoscopy of the stomach performed to exclude other problems like peptic ulcers, and in some instances, oesophageal manometry (measure of pressure along the oesophagus) can help identify if there are abnormalities in the peristaltic movement of the oesophagus, resulting in GERD.
In situations where, for example, a patient has severe GERD due to a hiatus hernia, surgery might be necessary to correct the situation. However, surgery will usually be offered as a last resort by your physician because GERD is not life threatening.
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Source by Tzun Hon Lau