Gastroesophageal Reflux Disease (GERD) - Causes, Treatment

Many people experience acid reflux, a condition in which the contents of their stomach move back into their oesophagus. This action of stomach contents returning to the oesophagus is known as acid regurgitation or gastroesophageal reflux. When the symptoms of acid reflux are experienced more than twice a week, the condition is known as Gastroesophageal Reflux Disease (GERD). In short, GERD is a chronic condition more severe than acid reflux.

Gastroesophageal Reflux Disease occurs in stages. The stage of GERD is determined by the symptoms a person experiences. The four stages of GERD are as follows:

1. Stage 1: Mild GERD: The patient experiences mild symptoms like infrequent heartburn and regurgitation once or twice a month. 
2. Stage 2: Moderate GERD: The patient experiences heartburn or regurgitation a few times a week. Untreated GERD symptoms in this stage can affect the patient’s daily activities. 
3. Stage 3: Severe GERD: The patient experiences regular heartburn, regurgitation, a chronic cough, a hoarse voice, and oesophageal inflammation. The quality of life is substantially lower in this stage. 
4. Stage 4: Oesophageal Cancer or Precancerous Lesions: Stage 4 results from several years of untreated severe GERD. Patients in this stage experience similar symptoms as stage 3, in addition to food getting stuck in the back of their throats while eating.
   1. About 10% of patients with unmanaged reflux advance to this stage and develop a precancerous condition called Barrett’s oesophagus. It may lead to cancer if left untreated.   

The primary symptoms of GERD are acid regurgitation and persistent heartburn. Heartburn feels like an uncomfortable burning in the chest, which can move up into the neck and throat. Other GERD symptoms may include:

1. A bitter or sour taste at the back of the mouth
2. Nausea
3. Chest pain
4. Hoarseness in the morning
5. Trouble swallowing
6. Pain when swallowing
7. Feels like a lump in the throat
8. Bad breath

People who have acid reflux at night may experience the following symptoms:

1. Chronic cough
2. Laryngitis (inflammation of the vocal cords)
3. New or worsening asthma
4. Sleep problems

Infants and children may experience similar GERD symptoms. In addition, they may experience the following:

1. Recurring small vomiting episodes
2. Excessive crying and refusal to eat
3. Breathing difficulties
4. A feeling of choking may wake up the child
5. Wet burps or hiccups
6. Weight loss or poor growth
7. Difficulty sleeping after eating

GERD is caused by frequent acid reflux that results from the relaxation or weakness of the lower oesophageal sphincter (a circular band of muscle around the bottom of the oesophagus). Normally, this valve closes tightly after food and liquid flow into the stomach.

However, if the valve weakens or does not relax as it should, the stomach contents can flow back into the oesophagus. The regular backwash of acid can irritate the oesophagus lining, causing it to become inflamed. 

Other possible causes of GERD include:

1. Hiatal Hernia: It is a condition in which a part of the stomach bulges above the diaphragm towards the chest area, getting in the way of normal food intake.
2. Frequently eating large meals: Large meals can cause distension of the upper stomach, decreasing pressure on the sphincter. As a result, it does not close properly. 
3. Lying down soon after large meals: This also decreases the pressure on the sphincter. 

Certain health factors and lifestyle choices can increase the risk of GERD. These factors include:

1. Obesity
2. Pregnancy
3. Delayed stomach emptying
4. Connective tissue disorders, like scleroderma
5. Smoking 
6. Eating large meals or late at night
7. Eating certain types of foods, like deep-fried or fatty foods
8. Certain beverages, like soda, coffee or alcohol
9. Certain non-steroidal anti-inflammatory drugs, like aspirin or ibuprofen

Occasional or mild cases of GERD can usually be prevented or treated by adopting a few lifestyle changes. Some tips for GERD treatment at home or to prevent the onset of GERD include:

1. Maintain a healthy weight.
2. Quit smoking.
3. Eat smaller, frequent servings rather than large meals a few times a day.
4. Eat food slowly and chew properly.
5. Stay upright for 45 to 60 minutes after eating.
6. Eat at least three hours before lying down or going to bed.
7. Reduce fat by decreasing the intake of butter, oil, fatty meats, salad dressings, and full-fat dairy products like cheese and sour cream.
8. Avoid wearing tight-fitting clothes that put pressure on your abdomen.
9. Elevate the head of the bed by 6 to 9 inches with the help of wood or cement blocks under the bedpost.
10. Avoid possible trigger foods and drinks, such as chocolates, caffeine, alcohol, etc. 

The healthcare provider diagnoses GERD based on the patient’s signs and symptoms and a physical examination. They may recommend some other tests to confirm GERD diagnosis or look for complications. These tests include:

1. Upper endoscopy: The doctor inserts an endoscope (a long tube with a light and camera) down the patient’s throat to look inside the oesophagus and stomach.
   1. An endoscopy can help detect inflammation of the oesophagus. It can also be used to collect a tissue sample (biopsy) to look for other complications. 
2. Ambulatory 24-hour pH probe: It is generally considered the gold standard for diagnosing GERD. In this test, a small catheter is threaded through the patient’s nose into the oesophagus for 24 hours.
   1. A pH sensor at the tube’s tip measures how long stomach acid regurgitates in the oesophagus. The sensor sends this data to a portable computer the patient wears around their waist or shoulder. 
3. Bravo wireless oesophageal pH monitoring: The test is similar to an ambulatory pH probe test. Instead of 24 hours, the patient wears the monitoring system for 48 hours. 
4. Esophogram: X-ray imaging is used to look for problems in the upper digestive tract after drinking a barium solution. 
5. Oesophageal manometry: During the test, the doctor passes a flexible tube through the patient’s nose into the oesophagus to measure the strength of the oesophageal muscles. The test is used for people who experience difficulty swallowing. 
6. Transnasal esophagoscopy: The test is used to look for any damage in the oesophagus or stomach with the help of a thin tube and video camera. 

How to Prepare for Doctor Consultation?

For GERD, the patient may be referred to a gastroenterologist (a doctor specialising in the digestive system). While preparing for the consultation, the patient can do the following:

1. Take a prior appointment.
2. Be aware of any pre-appointment restrictions.
3. Write down their signs and symptoms.
4. Write down their personal and medical information.
5. Make a list of their medicines, supplements, herbs, and vitamins.

Enlist questions for the doctor. Here’s what the patient can ask the doctor about GERD:

1. What is the cause of my symptoms?
2. What tests do I need for diagnosis?
3. Is my condition chronic?
4. Can it get worse if left untreated?
5. How can I prevent progression?
6. What complications should I look out for?
7. What treatment options are available?
8. Is surgery required?
9. Can it be managed without surgery?
10. What is the recovery time? 
11. Do I need to follow any restrictions?

Here’s what the patient can expect from the doctor during the consultation appointment:

1. When did you begin experiencing these symptoms?
2. How severe are your symptoms?
3. Are the symptoms persistent or occasional?
4. Does anything improve or worsen your symptoms?
5. Are the symptoms worse after eating or lying down?
6. Do these symptoms wake you up at night?
7. Do you experience difficulty swallowing?
8. Does food ever come up in the back of your throat?
9. Have you experienced any weight gain or loss?

For GERD treatment, the doctor usually recommends trying lifestyle changes and nonprescription medicines first. The doctor may recommend prescription medicines and other treatments if the patient does not get relief within a few weeks. 

GERD Treatment without surgery

Medications

Over-the-counter and prescription medicines for GERD include:

1. Antacids: Antacids can offer quick relief by neutralising stomach acids. 
2. H-2 Blockers: Histamine (H-2) blockers may reduce acid production from the stomach for up to 12 hours. 
3. Proton Pump Inhibitors: Stronger than H-2 blockers, these medications block acid production and heal the damaged oesophagus.   

Homoeopathy

Homoeopathy can be used as a treatment for early-detected cases of GERD with mild to moderate symptoms. It can also be a supportive treatment for patients with chronic GERD who are undergoing other treatments. Some commonly prescribed homoeopathic medicines for GERD include:

1. Natrum Phosphorica
2. Robinia
3. Iris versicolour
4. Nux Vomica
5. Lycopodium
6. Carbo Vegetabilis

Ayurveda

Ayurveda defines GERD as “Amlapitta”, i.e., the Pitta dosha (which regulates digestion) develops a sour taste from being burnt. Some common GERD treatments in Ayurveda include:

1. Pippali: stimulates digestion and balances the Pitta dosha:
2. Tulsi: relieves flatulence, gas, and hyperacidity.
3. Elaichi: facilitates digestion, reduces nausea, bloating, and bitter taste in the mouth.
4. Ash Gourd: decreases acid level in the gut and averts nausea, vomiting, and constipation.
5. Aloe Vera: neutralises stomach acids, heals peptic ulcers, and eases heartburn.

Please Note: The treatment approach and procedure selection are based on the patient’s health and the doctor’s opinion. 

Yoga and GERD

1. According to a study, 45.6% of people identify stress as a factor that impacts their GERD symptoms. Another study says that increased stress can cause an increase in acid secretion by the stomach. For years, yoga has proved effective for most people in reducing the body’s stress response.

While yoga for GERD cannot be used as a standalone treatment, it can be a part of the treatment plan. Yoga poses that can help reduce acidity include:

1. Supta Baddha Konasana (reclining bound angle)
2. Parsvottanasana (side stretch with upright modification)
3. Supported Supta Sukhasana (reclined easy cross-legged)
4. Trikonasana (triangle)
5. Parivrtta Trikonasana (revolved triangle)
6. Virabhadrasana 1 (Warrior 1)

GERD Treatment with surgery

GERD is generally managed with medications and lifestyle changes. However, if they don’t work or the patient cannot take medicines for a long period, the doctor may recommend surgery. The surgical options for GERD treatment include:

1. Fundoplication (or Laparoscopic antireflux surgery): It is a minimally invasive, standard surgical treatment used to treat acid reflux by creating a new sphincter at the bottom of the oesophagus. During the procedure, the surgeon wraps the upper part of the stomach around the lower oesophageal sphincter. This tightens the sphincter to prevent food from refluxing back into the oesophagus. 
2. Transoral Incisionless Fundoplication (TIF): It is a newer form of surgery that uses an endoscope to wrap the stomach around the lower oesophageal sphincter with polypropylene fasteners. It is less invasive than standard fundoplication and thus offers benefits like no scars and quick recovery. 
3. LINX device implantation: A LINX device is a ring of magnetic beads wrapped around the junction between the stomach and oesophagus during minimally invasive surgery. These magnets are strong enough to stop reflux but loose enough to let food pass into the stomach. 
4. Stretta procedure: In this procedure, the doctor puts a small tube down the oesophagus. The tube sends mild radiofrequency heat to the tissue, where the oesophagus joins the stomach to reshape the lower oesophageal sphincter. 

GERD is not a dangerous or life-threatening condition. However, long-term GERD or chronic oesophageal inflammation can lead to serious complications, such as:

1. Oesophagitis (Inflammation of the oesophagus): Stomach acid can cause irritation and inflammation in the lining of the oesophagus. Oesophagitis can cause bleeding, ulcers in the oesophagus, heartburn, chest pain, and trouble swallowing. 
2. Oesophageal stricture (Narrowing of the oesophagus): Damage to the lining of the oesophagus can sometimes form scar tissues, causing the narrowing of the oesophagus. These strictures can lead to problems with eating, drinking, and swallowing. 
3. Barrett’s oesophagus (Precancerous changes to the oesophagus): The condition develops in about 10% of people with long-term GERD. Damage from stomach acid can cause changes in the cells in the lining of the lower oesophagus, increasing the risk of oesophageal cancer. 
4. Oesophageal cancer: It can be divided into two types:
   1. Adenocarcinoma (develops in the lower part of the oesophagus and progresses from Barrett’s oesophagus)
   2. Squamous Cell Carcinoma (begins in the cells that line the upper and middle part of the oesophagus). 

When to See a Doctor?

The patient should call their healthcare professional in the following situations:

1. Experience severe or frequent GERD symptoms.
2. The condition is not improving with at-home remedies.
3. Trouble swallowing or persistent nausea or vomiting.
4. Over-the-counter medications are not effective.
5. You have a family history of Barrett's oesophagus or oesophagal cancer.

The diet and eating habits of the patient play a key role in managing GERD symptoms. Patients should avoid trigger foods that keep giving them heartburn. Certain food items that may trigger symptoms of GERD include:

1. Fried foods
2. Spicy foods
3. Fatty foods (including dairy products)
4. Chocolate
5. Peppermint
6. Foods with tomato products
7. Citrus fruits
8. Garlic and onion
9. Coffee, alcohol, and carbonated drinks

If a person avoids these foods and still experiences the symptoms of GERD, they must consult a doctor for some other underlying condition that may be causing the symptoms. 

If you experience occasional heartburn due to GERD, you are not alone! While GERD may cause several uncomfortable symptoms, there are effective management strategies to counter the condition. Over-the-counter medications and lifestyle changes can usually cause relief. However, the doctor may recommend prescription medicines or surgery if the condition worsens. 

Consult a professional at HexaHealth if you experience persistent GERD symptoms. Our team of experts can help you diagnose your condition and recommend management strategies like lifestyle and dietary changes. If you google “GERD doctor near me”, you may end up confused with the plethora of online options. But fret not! At HexaHealth, we will help you connect with the best doctors and surgeons as per your needs and requirements.