Gastro-Esophageal Reflux Disease (GERD)

 If you are reading this, you or someone you know has been diagnosed to have gastro-esophageal reflux disease (GERD).

GERD is the backward movement (reflux) of gastric contents into the esophagus and into the pharynx. Physically, GERD occurs when a muscular valve at the lower end of the esophagus malfunctions. Normally, this muscle closes to keep acid in the stomach and out of the esophagus. The continuous entry of acid or refluxed materials into areas outside the stomach can result in significant injury to those areas.

Symptoms of GERD

The stomach is highly acidic whereas the pH of the throat is alkaline. When the highly acidic contents of the stomach reflux into the alkaline environment of the throat it starts a chemical reaction that manifests as sensation of a lump in throat, throat discomfort or irritation. There may be a change in the quality of voice or even hoarseness. Increase in secretions in throat result in habitual throat clearing. These secretions may be mistaken as post nasal drip or “phlegm”. Symptoms may be worse at night or early in the morning. Some patients may experience coughing at night with a sense of “choking”. In severe cases patients may develop symptoms of sensation of blocked ears and sinusitis.

 How is GERD diagnosed?

Diagnosis is based on a detailed history and a complete examination including flexible naso-laryngoscopy. The examination may show some tell-tale signs such as mucosal oedema at the junction of the oesophgus and the larynx, oedema of the vocal cords or even vocal cord polyps. Frequently the examination may be normal but that does not exclude the diagnosis of GERD.

Occasionally a barium study or an esophagoscopy may be indicated in some refractory cases.

 What treatments for GERD are available?

Lifestyle changes:

  • Try to achieve an optimal weight. Obesity promotes reflux.
  • Avoid tight clothing around mid-section of your body.
  • Raise the head of the bed about 30 degrees
  • Eat smaller, more frequent meals instead of large amounts of food at one sitting.
  • Avoid dinner immediately before bed; instead, let two or three hours pass.

 

Dietary changes: Avoid chocolate, carbonated drinks, caffeine, tomato products, peppermint, and other acidic foods as citrus juices. Fried foods and spicy foods are also known to aggravate symptoms.

 

Medical Treatment: Most of the medications prescribed to treat GERD either break down or lessen intestinal gas, decrease or neutralize stomach acid, or improve intestinal coordination. Currently the trend is to prescribe PPIs ( Proton Pump Inhibitors). PPI limit the production of acid in the stomach alleviating symptoms. However, these measures may be temporary.

 

Surgical Treatment: Rarely necessary. May be an option for some cases.