What is Gastroesophageal Reflux Disease?
GERD – more commonly known as acid reflux – is the condition where the contents in your stomach backflows up into your oesophagus regularly, causing bothersome symptoms, and can even damage the oesophagus.
When we swallow, food travels down the oesophagus to the stomach through a rhythmic wave of contraction, also known as peristalsis. The lower oesophagus sphincter, a muscular ring which sits at the bottom end of the oesophagus subsequently relaxes, allowing food to pass through. Once the food enters the stomach, the muscle contracts to prevent food and stomach acid from going back up the oesophagus.
However, these sphincter muscles may sometime weaken and allow stomach acid to backflow regularly, irritating your oesophagus lining.
What are the symptoms of GERD?
The typical symptoms of GERD are:
- Regurgitating sour liquid
In some patients, they may have atypical symptoms as a result from the acid reflux, such as:
- Persistent cough
- Throat discomfort
- Difficulty breathing
- Bad breath
- Chest pain
What are the complications of GERD?
Long term acid reflux may result in injury to the oesophagus, also known as oesophagitis. If severe, stricture or narrowing may occur, which result in
In rare instances, patients may even develop a precancerous condition known as Barrett’s oesophagus, which carry a very low risk of progression to oesophageal cancer.
How is GERD diagnosed?
Diagnosis of GERD is usually made based on typical symptoms. Your doctor may sometime recommend further procedures such as:
Gastroscopy is a flexible endoscope which allows your doctor to examine the internal lining of your oesophagus and stomach. This may be necessary to assess the damage caused by reflux and to look for any complications such as ulcer, narrowing, or cancerous growth.
24-hour oesophageal pH study
A long, thin, flexible tube fitted with sensors will be inserted through the nose into the oesophagus. Over the course of 24 hours, it will measure any reflux event in the lower oesophagus. This allows your doctor to confirm the acid reflux and to correlate with your symptoms.
What are the causes of GERD?
Certain conditions increase the risk of GERD. They include:
- Being overweight
- Certain medical conditions:
- Hiatal hernia (where part of your stomach protrudes into your chest through an opening at the diaphragm, which results in reduced pressure of the lower oesophageal sphincter)
- Scleroderma (an autoimmune disease which results in ineffective peristalsis of the oesophagus, therefore inability of the oesophagus to clear the acid content back flowed from the stomach)
- Gastroparesis (the inability of the stomach to empty properly)
- Certain medications such as calcium channel blockers and certain asthma medications
- Lifestyle choices:
- Supper before sleeping
- Eating too quickly
- Eating food high in fat, chocolate, mint, garlic, onion
- Drinking alcohol or coffee
When should you seek medical care?
Seek immediate medical attention if:
- Your symptoms are bothersome
- You notice any alarming symptoms, such as
- Loss of appetite
- Weight loss
- Difficulty swallowing
- Pain while swallowing
- Vomiting, especially with blood in the vomitus
- Chest pain (this can sometime be a sign of heart attack)
What are the treatment options available?
GERD can be managed successfully for majority of patients via a combination of lifestyle modification and medications.
- Avoid heavy meals, especially if they are greasy
- Avoid taking supper within 4 hours from time of sleeping
- Weight loss
- Avoid tight-fitting clothing which increases the pressure in the abdomen, thus increasing the chances of reflux
You may first try over-the-counter medications such as antacids. They work by neutralising the gastric acid.
If your symptoms are persistent, your doctor may prescribe the following medications which work by reducing acid production:
- Histamine Receptor Antagonist (H2RA) such as famotidine or cimetidine;
- Proton Pump Inhibitors (PPI) such as omeprazole, esomeprazole, pantoprazole, rabeprazole and dexlansoprazole, or;
- Potassium Competitive Acid Blocker (PCAB) such as vonoprazan
These medications are generally safe, and your doctor will discuss with you in detail should your symptoms warrant the use of the medication. Treatments are usually intended to control symptoms using as small a dose of medication as possible, and tailored according to the frequency and severity of symptoms.
Endoscopic and surgical procedures
Various endoscopic and surgical procedures have been invented to treat GERD via artificially increasing the lower oesophageal sphincter pressure. These generally have limited role as majority of patients with GERD can be treated effectively with lifestyle modification and medications.
Example of endoscopic therapies include:
1. TIF (Transoral Incisionless Fundoplication)
In this procedure, a medical device is inserted through your mouth to create folds at the distal oesophagus. A barrier is thus created between the stomach and the oesophagus, preventing acid reflux.
2. Stretta Procedure
This procedure uses radiofrequency energy which is delivered to the distal oesophagus. The thermal injury reduces tissue compliance and therefore achieves the target effect of reduced relaxation of the lower oesophageal sphincter.
- Fundoplication is a surgical procedure where the upper part of stomach is wrapped and stitched together at the lower oesophagus. This strengthens and increases the pressure at the lower oesophagus sphincter, thereby reducing acid reflux.
Patients with an abnormal pH study and who do not respond to or are intolerant of medical treatment can consider this treatment option. If you suspect that you may be suffering from GERD, consult a gastroenterologist for an evaluation.
Article reviewed by Dr Shim Hang Hock, gastroenterologist at Parkway East Hospital
Philip O Katz et al. Guidelines for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology. 2013 Mar;108(3):308-28
V Raman Muthusamy et al. The role of endoscopy in the management of GERD. Gastrointestinal Endoscopy. 2015;81(6):1305-10.