Most often the terms GERD, Acid Reflux and Heartburn are used interchangeably but the truth is that they are three separate conditions

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that can affect people of any age. As a part of the digestive process, the stomach releases digestive acids to break down the food we eat. GERD occurs when these stomach acids flow back (acid reflux) into the esophagus or food pipe. The stomach lining is tough enough to handle the digestive acids, but the esophageal lining is not. Hence, the acid reflux causes irritation depending on the severity and recurrence.

WHAT CAUSES GERD?

At the end of the esophagus there is a small ring that expands to allow the entry of food into the stomach cavity. It contracts to prevent the substances from the stomach from entering the esophagus. This ring is called the Lower Esophageal Sphincter (LES). Acid reflux occurs due to dysfunction of the LES where it remains relaxed for longer than required allowing the flow of stomach acids into the esophagus. The constant backwash of acid irritates the lining of the esophagus, leading to inflammation. Frequent Acid Reflux causes GERD – mild acid reflux once/twice a week or severe acid reflux at least once a week.

Hiatal Herniation is another cause for GERD. This occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (the muscle that separates the abdomen from the chest). The opening is supposed to support the functioning of the LES, that lies at the same level as the diaphragm. When hiatal herniation occurs, this small opening in the diaphragm and the LES are no more at the same level and this counters the proper expansion and contraction of the LES, resulting in frequent flow of stomach contents into the esophagus. Thereby causing GERD.

GERD and HEARTBURN

Most often the terms GERD, Acid Reflux and Heartburn are used interchangeably but the truth is that they are three separate conditions.

Acid Reflux is the flowing of stomach acids into the esophagus causing irritation and inflammation of the esophageal lining. Chronic Acid Reflux is GERD.

Heartburn however is the burning sensation in the chest caused when stomach acids attack the esophageal lining. The pain can be from mild to severe and is sometimes even mistaken for heart attack pain. Heartburn could feel like a burning sensation moving from the chest to the throat. It could also cause chest tightening or discomfort just behind the breastbone. Heartburn usually occurs soon after a heavy meal. Frequent severe heartburn can be a symptom of an underlying digestive disorder such as GERD.

GERD SYMPTOMS

• Burning sensations(heartburn) in the chest after eating which might be worse at night.
• Difficulty in swallowing
• Chest pain
• A sour taste in the throat caused by backwash of stomach acids
• Regurgitation of food
• Chronic Coughing
• Worsened asthma
• Disrupted sleep at night
• Laryngitis

Most often GERD can be managed with medication and a few lifestyle changes. In the rarest of cases, it might require surgical intervention.

PEOPLE AT RISK OF ACQUIRING GERD

Acid Reflux and Heartburn are common occurrences. However, the frequency and intensity at which they occur determine whether an individual has GERD. As in most medical conditions certain groups of people are more prone to GERD than others.

• Obesity increases pressure in the abdomen region, which could lead to a hiatal hernia.
• People with Gastroparesis in which the stomach empties slower, thereby prolonging the distention of the stomach with food after meals, leading to transient LES relaxation.
• Pregnant women are also prone to GERD caused by altered functioning of the LES
• Connective tissue disorders, such as scleroderma can also make an individual more susceptible to GERD.

TREATING GERD

Making changes in diet and lifestyle is the simplest and best way to manage GERD and prevent further complications.

Some changes to consider are:

• Eating smaller meals. No over-eating.
• Having dinner at least 2-3 hours before going to bed
• When lying down, elevate the head of the bed by 6-8 inches.
• Losing weight if on the heavier side
• Quit or avoid smoking

Medications that will help manage GERD

• An Antacid. It counters the stomach acids that irritate the oesophagus.
• H2 Blockers that inhibit excess acid production.
• Prokinetics help empty the stomach faster.
• Antibiotics that might help empty the stomach faster.

When lifestyle changes and medications do not control GERD, surgical intervention might be the only solution. The options are:

• Endoscopy procedures are done to tighten the LES
• Fundoplication involves sewing up the top of the stomach around the esophagus to add pressure to the lower end of the esophagus in order to reduce reflux

While most GERD medications are available over the counter, it is always best to get a gastroenterologist’s opinion instead of self-medication. Your doctor will be the best guide to tell you how far the disease has progressed and prescribe a treatment that is customized to your condition. While GERD is generally chronic, it is definitely treatable with disciplined and diligent care.