It is a condition in which the gastric contents reflux back into the esophagus. Small amount of reflux is normal & is present in many people. However when it becomes excessive & begins to irritate the esophageal lining cells it is called GERD.

What causes GERD?--

GERD occurs when the lower esophageal sphincter fails to maintain a barrier between the stomach & the esophagus. This can be caused by various factors. One of the common reversible factor is obesity.

What are the symptoms--

• Heartburn
• Regurgitation of bitter fluid into the back of the mouth.
• Sometimes, cough & voice disorder.

The symptoms are most likely after meals. They are often exacerbated by bending, lifting heavy weights.

What investigations are required for GERD?--

Generally GERD is a clinical diagnosis. Esophagogastroduodenoscopy may be required in some cases. Advanced investigations like esophageal pH monitoring & manometry are rarely required.

Esophagoscopic view showing inflammed esophagus due to GERD

Treatment--

Very important factor in treatment of GERD is the dietary & lifestyle changes.

• Raise the head of the bed by 6 inches.
• Have dinner early. Go to bed at least 2-3 hours after having dinner.
• Smaller frequent meals are preferable to larger bulkier meals.
• Lose weight if obese.
• Avoid smoking.
• Avoid peppermint, chocolate & alcohol; they reduce the tone of the lower esophageal sphincter.

Drugs--

• Antacids & alginates--do provide symptomatic relief but not very useful for long term management.
• Prokinetics--Cisapride increases the tone of the sphincter.
• H2 receptor blockers--eg. Ranitidine. Help by decreasing acid secretion.
• Proton pump blockers--eg. Omeprazole. Very effective in reducing irritation of the esophagus.

Surgery--

Undertaken only in cases totally refractory to drugs & also in complicated GERD.

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