GASTROESOPHAGEAL REFLUX DISEASE (GERD)

BACKGROUND

Acid reflux is when the acid that is normally in your stomach backs up into the esophagus, tube that carries food from your mouth to your stomach. Another term for acid reflux is "gastroesophageal reflux disease," or GERD.

DISEASE OCCURRENCE IN POPULATION:

Western dietary habits have made GERD a common disease. Richter and associates reported that 25-40% of Americans experience symptomatic GERD at some point.

Reported prevalence of GERD is 24% in Pakistan as per data of 2005.

RISK FACTORS:

Conditions that can increase your risk of GERD include:

• Obesity
• Bulging of top of stomach up into the diaphragm (hiatal hernia)
• Pregnancy
• Smoking
• Dry mouth
• Asthma
• Diabetes
• Delayed stomach emptying
• Connective tissue disorders, such as scleroderma.

SIGN AND SYMPTOMS:

The symptoms include:

• Burning in the chest, known as heartburn
• Burning in the throat or an acid taste in the throat
• Stomach or chest pain
• Trouble swallowing
• Having a raspy voice or a sore throat
• Unexplained cough

DIAGNOSTIC TEST:

Diagnosis of GERD is based on:

• Your symptoms: Your doctor may be able to diagnose GERD based on frequent heartburn and other symptoms.
• A test to monitor the amount of acid in your esophagus: Ambulatory acid (pH) probe tests use a device to measure acid for 24 hours. The device identifies when, and for how long, stomach acid regurgitates into your esophagus. One type of monitor is a thin, flexible tube (catheter) that's threaded through your nose into your esophagus. The tube connects to a small computer that you wear around your waist or with a strap over your shoulder.

Another type is a clip that's placed in your esophagus during endoscopy. The probe transmits a signal, also to a small computer that you wear. After about two days, the probe falls off to be passed in your stool. Your doctor may ask that you stop taking GERD medications to prepare for this test.

If you have GERD and you're a candidate for surgery, you may also have other tests, such as:

• An X-ray of your upper digestive system: Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine (duodenum).
• A flexible tube to look inside your esophagus: Endoscopy is a way to visually examine the inside of your esophagus and stomach. During endoscopy, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat.

Your doctor may also use endoscopy to collect a sample of tissue (biopsy) for further testing. Endoscopy is useful in looking for complications of reflux, such as Barrett's esophagus.

• A test to measure the movement of the esophagus: Esophageal motility testing (manometry) measures movement and pressure in the esophagus. The test involves placing a catheter through your nose and into your esophagus.

TREATMENT OPTIONS:

There are a few main types of medicines that can help with the symptoms of acid reflux: antacids, surface acting agents, histamine blockers, and proton pump inhibitors. All of these medicines work by reducing or blocking stomach acid. But they each do that in a different way.

Antacids and surface acting agents can relieve mild symptoms, but they work only for a short time. Histamine blockers are stronger and last longer than antacids and surface acting agents.

Proton pump inhibitors are the most effective medicines in treating GERD. Some of these medicines are sold without a prescription. But there are other versions that your doctor or nurse can prescribe.

PRECAUTIONS:

• Lose weight (if you are overweight)
• Raise the head of bed by 6 to 8 inches
• Avoid foods that make your symptoms worse (examples include coffee, chocolate, alcohol, peppermint, and fatty foods)
• Cut down on the amount of alcohol
• Stop smoking, if you smoke
• Eat a bunch of small meals each day, rather than 2 or 3 big meals
• Avoid lying down for 3 hours after a meal

REFERENCES:

• https://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-disease-in-adults-the-basics?source=see_link
• Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment.J Gastrointest Surg. 2007 Mar. 11(3):286-90
• Jafri N, Yakoob J, Islam M, Manzoor S, Jalil A, Hashmi F. Perception of gastroesophageal reflux disease in urban population in Pakistan.J Coll Physicians Surg Pak. 2005;15:532–4.
• http://www.mayoclinic.org/diseases-conditions/gerd/basics/risk-factors/con-20025201