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31-01-2019
Gastric reflux or GERD – Dr Ganesh Discusses

It goes by the common name of acid reflux or heartburn. The simple medical term is GERD or more specifically gastro oesophageal reflux disease. The symptoms are just as varied. They include burning sensation in the chest, sour taste in the mouth or even lower chest pain. These complaints are getting more common and significantly they are now appearing in the younger age group, even teenagers.

In a nutshell, it is caused by acid from the stomach coming up the oesophagus. This usually does not happen as the junction between the oesophagus and stomach has a one way valve allowing food down but not the stomach acid to track backwards. The oesophagus is more sensitive than the stomach and develops pain and discomfort when acid ‘burns’ it.

The important question is why does the acid travel backwards from the stomach to the oesophagus? This is due to either laxity or weakness at the one-way valve at the junction or a prolonged increased pressure from the stomach upwards. Risk factors include obesity, stress, eating large meals, eating late at night, acidic foods like coffee, spicy food, alcohol and smoking. Even pregnancy can aggravate GERD. Finally a hiatus hernia, or weakness in the diaphragm can cause it too.

A lifestyle change can help a lot. Start off by eating small meals and losing weight. Have your last meal of the day, dinner, at least 3 hours before you sleep and if the symptoms are severe, sleep with a head up posture by adding more pillows. Consume less acidic food like coffee, spicy food, vinegar and aerated drinks, and of course refrain from alcohol and smoking.

At this stage of the symptoms persist, please see your doctor. Medication comes next. The usual medication prescribed are those to reduce acidity and those to increase motility of the gut away from the oesophagus thus reducing the volume of reflux.

After assessment by a doctor, the usual recommendation is a gastroscopy to assess the inner lining of the stomach and oesophagus for inflammation or progression of the disease. Other tests like a manometry, pH measurements and a barium swallow are useful in assessing the severity of the disease.

GERD can cause inflammation or redness and swelling of the lower oesophagus and this may lead to pain, narrowing or even ulcers that can cause bleeding. Rarely, and importantly, if left untreated or undiagnosed, it may lead to cancer! So please start your lifestyle change as soon as possible!

 

Treatment of GERD

The mantra of Dr Ganesh is always diet and lifestyle change. This is the best known treatment of reflux! Usually by reversing the cause of reflux, the symptoms and harmful effects of GERD can be cured.

Consuming less acidic food and beverages will certainly go a long way to relieve symptoms. These commonly include coffee, spicy foods, vinegar and aerated or gassy drinks. Alcohol consumption and smoking are also part of the problem that aggravates reflux.

Just as important are our dietary habits. The recommendation is to take small portion size meals multiple times a day. And to take the last meal of the day at least 3 hours before bed. Sleeping on a full stomach will encourage the stomach contents to be pushed into the oesophagus and causes you to wake up at night with the burning sensation in the chest! Also if these symptoms already persist, elevating the head while sleeping is a simple measure that can help alleviate the discomfort. This can be done by either adding more pillows beneath the head or even changing the angle of the bed to a head-up position. Finally, and importantly, a stress free life is a huge positive factor to eradicate this disease!

If the reflux is severe, these measures may not bring relief. Seek the opinion of a doctor and medication may help. Broadly, they can be divided into medication that reduces acid in the stomach and medication that increases the movement of the bowel to push the acidic mixture of the stomach towards the small intestines and away from the oesophagus. This will allow the oesophagus to heal and reduce the burning symptoms and reduce the possible complications of the inflammation.

Surgery is the last resort when all these measures fail, and the discomfort is still not relieved. “The procedure has to be earned and not offered” is the phrase most upper gastrointestinal surgeons use to describe surgical treatment of GERD. A Fundoplication is the procedure done to help relieve the symptoms of GERD. This surgery entails the wrapping of the upper stomach around the lower oesophagus thereby creating a new ‘valve’ to prevent acid from moving from the stomach to the oesophagus. A second procedure may he added at the same time. A repair of the hiatus hernia or opening in the diaphragm may be performed simultaneously if it is present. These procedures are now done by laparoscopy or key-hole surgery and has a success rate of about 60 to 70%. In view of the success rate and other side effects like slow flow of food to the stomach, excessive burping and the usual complications of any abdominal surgery, this option is only offered as the last resort.

In other words, you have to prove yourself to your surgeon that you have earned the surgery of Laparoscopic Fundoplication with certain criteria like persistent daily symptoms for many months, despite high dose medication and full compliance to lifestyle changes.

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