Heartburn, GERD

GERD is Gastro (stomach)-Esophageal (food pipe) Reflux (flow back) Disease.

Esophagus is the tube that carries food from mouth to stomach. Gastro esophageal reflux disease (GERD) or acid reflux is stomach contents (acid and digestive juices)comes up or reflux, into the esophagus and irritate it. Result is heart burn burning sensation in throat/chest.

Occasional reflux is common , reflux more than twice a week is GERD

What Causes GERD?

Food travels from mouth to stomach through a tube called the gullet or esophagus. At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES) which allows food to pass through into the stomach but prevent back-flow of stomach juices (acid) into the esophagus.

GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus..

What are the Risk Factors for GERD?

Common foods that can worsen reflux symptoms:

  • Citrus fruits

  • Chocolate

  • Soda

  • Drinks with caffeine or alcohol

  • Fatty and fried foods

  • Garlic and onions

  • Mint flavorings

  • Spicy foods

  • Tomato

Eating Habits:

  • Smoking and Alcohol

  • Obesity or overweight

  • Stress

  • Hiatal Hernia

  • Medicines. NSAIDS, medicines used to treat asthma, high blood pressure, heart problems, anxiety, insomnia, depression, pain, Parkinson’s disease, muscle spasm, or cancer.

  • Exercise. Increased pressure on the abdomen can increase the risk of acid reflux. Weightlifters had the most heartburn and acid reflux

Symptoms of GERD

  • Burning throat or chest (heart burn)

  • Regurgitation of stomach acid and food content

  • Sour taste in the mouth

  • Chest pain

  • Belching

  • Excessive salivation

  • Feeling of lump in throat, difficulty in swallowing

  • Chronic cough, night time breathing difficulty

  • Hoarseness of voice

  • Post nasal drip frequent sore throat, Excessive clearing of the throat

  • Choking spells.

In infants and children, GERD may cause repeated vomiting, coughing, and other respiratory problems.

Alarm Symptoms:

  • Loss of weight, blood in stool or vomiting

  • Severe Anaemia and weakness, dysphagea

  • Patient over 50 years with dyspepsia

Management of GERD

If you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than 2 weeks visit a gastroenterologist.

Life style changes: Self care (How to prevent Heart burn)

  • Quit smoking /Avoid alcohol

  • Avoid citruos fruits, coffee, peppermint, oily/spicy food, tomato, cola drinks

  • Weight loss for obese

  • Regular and periodic small meals- don’t escape break fast, keep dinner light

  • Avoid exercising, bending, lying down for 2 hours after eating.

  • Raise head end of bed, sleep on your left side

Management of GERD:

  • Antacids

  • Antihistamines and pro kinetics

  • Proton pump inhibitors

Surgery in Refractory Cases

The most common surgical procedure performed for treatment of GERD is a Nissen fundoplication.

Fundoplication refers to wrapping the distal esophagus with the uppermost part of the stomach, now performed using minimally invasive techniques. Patients have small incisions, less pain, short hospital stay and return to normal activity sooner.

With advances in techniques many experts now believe that laparoscopic fundoplication should be considered as primary treatment in patients who are candidates for long-term maintenance drug therapy.

Success rate of operation has been excellent. About 90% of patients are free of heartburn and respiratory symptoms after the operation. The procedure may enhance stomach emptying.

What if GERD Symptoms Persist? How is GERD Diagnosed?

  • Thorough clinical history

  • Upper Endoscopic examination-link

  • X-Ray barium swallow-to help diagnose hiatal hernia or other structural problems

  • Ambulatory esophageal Ph monitoring

  • CBC to see Anaemia/ stool for blood in stool

What are the Long-term Complications of GERD?

Chronic untreated GERD can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers—also called esophagitis. Scars from tissue damage can lead to strictures—narrowing of the esophagus—that make swallowing difficult.

Some people develop Barrett’s esophagus, in which cells in the esophageal lining take on an abnormal shape and color. Over time, the cells can lead to esophageal cancer.

Studies have shown that GERD may worsen or contribute to asthma, chronic cough, choaking and pulmonary fibrosis.

How Do You Know If It’s Heartburn or Your Heart?

  • Are you sweaty?

  • Do you have palpitations?

  • Are you short of breath?

If any of those symptoms occur with the heartburn, you should see a physician and make sure it is not heart-related.

GERD in Children

Most infants with GER are healthy even if they frequently vomit. Reflux that continues past 1 year of age may be GERD. GERD can present as repeated regurgitation, nausea, heartburn, coughing, laryngitis, or respiratory problems like wheezing, asthma, or pneumonia. Infants with GERD may refuse to feed and experience poor growth.

Simple strategies for avoiding reflux, are burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding.

For older child self care it is same as adult.

For information about GER in infants, children, and adolescents, see the Gastroesophageal Reflux in Infants and Gastroesophageal Reflux in Children and Adolescents fact sheets from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)


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