- Risk factors for GERD are direct consequences of lifestyle and diet
- Medication like mild antacids may be prescribed in mild to severe cases
- Extreme cases may require surgery (Fundoplication) and stronger medicines
We all have had someone tell us to always 'follow our gut feeling' when we're anxious or stressed. While most of us have perceived the phrase as something emotional, you'd be surprised to know that it also applies in terms of your physical well-being. The gastrointestinal system is not only the body's prime site of absorbing nutrients, but it also acts as a communication center to and from the brain, and functions as one of the body's frontlines in the fight against disease. However, with increasing urbanisation and a highly competitive environment, the day-to-day healthy routine of majority of the people have changed drastically leading to them falling prey to various disorders.
One such serious digestive disorder is acid reflux or gastro oesophageal reflux disease (GERD). GERD is typically defined as the phenomena when acidic liquid contents from stomach frequently back up into the food pipe leading to injury or inflammation in the lining of the food pipe (oesophagus). It is caused either by increased acid output or when the junction of the food pipe and stomach has a loose/weak muscle valve due to which the LES (lower oesophageal sphincter) doesn't close properly or tightly enough resulting in the food content to rise back up into the oesophagus. If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your oesophagus.
One can easily confuse the symptoms of GERD for a simple case of gastric problem. Some of them are burning sensation in your chest, usually after eating, have difficulty in swallowing or regurgitation (bringing up) of food. Apart from these, other symptoms to look out for are a lump in your throat, chronic cough, laryngitis, new or worsening asthma and disrupted sleep.
According to recent studies carried out by The Indian Society of Gastroenterology the prevalence of GERD in India is likely to be between 8% and 19%, which is comparable to GERD prevalence rates published in western countries. Additionally, these studies highlight that the risk factors for GERD are related to diet and lifestyle choice; which are both modifiable risk factors such as:
- Delayed stomach emptying
- Having large meals or eating late at night
- Eating trigger foods rich in fat or fried
- Consumption of alcohol, carbonated drinks, coffee, tea and caffeine rich energy drinks.
- Frequent use of medications like aspirin, painkillers
Mild GERD (acid reflux occurring only once a week) is quite common and may be managed with some lifestyle changes and mild over the counter medicines, however, severe GERD (Acid reflux once a day) may need stronger medications or in refractory situations even surgery to ease symptoms.
Doctors usually diagnose GERD based on symptoms and physical examination. Sometimes a short duration of treatment with mild antacids may be advised to see for response specially in the absence of any worrying symptoms. Further evaluation for diagnosis confirmation or for refractory symptoms includes upper gastrointestinal endoscopy, 24 hour ambulatory acid (ph) and impedance probe test, oesophageal manometry and an x-ray of your upper digestive system.
The first step in management of GERD is lifestyle modification which includes eating on time, increasing physical activity, avoiding fatty and fried food, not smoking or consuming alcohol and/or carbonated drinks. Cutting down significantly on tea and coffee also helps.
In case the above remedies do not work, the below medications also help, however, should be taken for a short duration of time:
1. Liquid antacids: Antacids, such as Digene, Mucaine gel and Gaviscon etc. may provide quick relief. But antacids alone won't heal an inflamed oesophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhoea or sometimes kidney problems.
2. Medications to reduce acid production: These medications - known as H-2-receptor blockers - include famotidine and ranitidine. H-2-receptor blockers don't act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours.
3. Medications that block acid production and heal the oesophagus: These medications - known as proton pump inhibitors - are stronger acid blockers than H-2-receptor blockers and allow time for damaged oesophageal tissue to heal. Examples are Omeprazole, Pantoprazole, Rabeprazole etc. Although these medications bring quick relief they should not be used indiscriminately and long term as that can lead to serious infections and deficiencies.
4. Medication to strengthen the lower oesophageal sphincter: Baclofen may ease GERD by decreasing the frequency of relaxations of the lower oesophageal sphincter. Serious side effects might include fatigue or nausea and even loss of consciousness. This medicine should strictly be taken only under medical supervision and in very selected situations.
5. Fundoplication (Surgery): While, GERD can usually be controlled with medication. But if medications don't help or you wish to avoid long-term medication use, your doctor might recommend Fundoplication. The surgeon wraps the top of your stomach around the lower oesophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete.
Therefore, if your gut starts rejecting food, please do not try to self-diagnose, instead visit a medical expert. Adding to that, you should immediately see a doctor in case you're experiencing frequent GERD symptoms, taking medicines for heartburn more than twice a week or getting severe chest pain with breathlessness.
(Dr. Shanti Swaroop Dhar, Principal Consultant - Gastroenterology, Max MultiSpeciality Centre, Panchsheel Park)
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